Individual
JILL FANNIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED., CCC-SLP
Contact information
Practice address
212 RIVERSTONE DR, CANTON, GA 30114-5256
(770) 345-7796
Mailing address
212 RIVERSTONE DR, CANTON, GA 30114-5256
(770) 345-7796
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP006405
GA
Other
Enumeration date
04/08/2009
Last updated
04/11/2011
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