Individual
ELLEN REBECCA GRADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3105 CREEKSIDE VILLAGE DR NW STE 604, KENNESAW, GA 30144-4218
(770) 974-2424
Mailing address
220 26TH ST NW APT 6207, ATLANTA, GA 30309-1929
(678) 910-5404
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP009786
GA
Other
Enumeration date
01/23/2019
Last updated
01/23/2019
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