Individual
MRS. BRENDA R. ETHRIDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
GSL-SP.
Contact information
Practice address
158 ALBERT GRIMSLEY DR, COCHRAN, GA 31014-8321
(478) 934-1728
Mailing address
158 ALBERT GRIMSLEY DR, COCHRAN, GA 31014-8321
(478) 934-1728
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
001141
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000720695B
—
GA
Enumeration date
11/11/2009
Last updated
11/11/2009
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