Individual
MRS. VERNELL S FORMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA./CCC/SLP
Contact information
Practice address
3294A DOG RIVER RD, THEODORE, AL 36582-2524
(251) 443-5154
(251) 661-2579
Mailing address
3294A DOG RIVER RD, THEODORE, AL 36582-2524
(251) 443-5154
(251) 661-2579
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2648
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00289025
SPEECH-LANGUAGE PATHOGIST
AL
Enumeration date
11/06/2007
Last updated
11/06/2007
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