Individual
SUSIE BOUSTEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS CCC-SLP
Contact information
Practice address
4461 S MAIN ST, ACWORTH, GA 30101-5555
(770) 691-3900
Mailing address
6303 CHEATHAM LAKE DR NW, ACWORTH, GA 30101-7646
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
07/18/2018
Last updated
07/18/2018
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