Individual
DEMETRIA L PHILLIPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED., CCC-SLP
Contact information
Practice address
2623 WHISPERING PINES DR, GRAYSON, GA 30017-2859
(770) 875-2331
(770) 978-0077
Mailing address
2623 WHISPERING PINES DR, GRAYSON, GA 30017-2859
(770) 875-2331
(770) 978-0077
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP005115
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10037022
—
GA
01
—
12038676
ASHA #
GA
05
—
305510
—
GA
01
—
SLP005115
GA STATE LICENSE
GA
Enumeration date
11/12/2006
Last updated
07/09/2007
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