Individual
JACQUELYN SUZANNE LAVENDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
8770 GLASGOW POINTE, DULUTH, GA 30097-6606
(440) 497-8499
Mailing address
2746 BERKSHIRE DR, WINDER, GA 30680-6121
(770) 362-6939
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP005556
GA
Other
Enumeration date
11/25/2022
Last updated
11/25/2022
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