Individual
MARCIA B BASSETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED. CCC-SLP
Contact information
Practice address
912 KILLIAN HILL RD SW, SUITE 103, LILBURN, GA 30047-3138
(770) 638-7200
(770) 638-7265
Mailing address
912 KILLIAN HILL RD SW, SUITE 103, LILBURN, GA 30047-3138
(770) 638-7200
(770) 638-7265
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
004073
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10054033
AMERIGROUP
GA
01
—
11541610
CAQH
GA
01
—
331761
WELLCARE
GA
01
—
52172948001
BLUE CROSS
GA
01
—
7395784
AETNA
GA
Enumeration date
11/01/2006
Last updated
07/09/2007
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