Individual
MRS. PAMELA POWELL ANDEREGG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
519 RALPH RAHN RD, RINCON, GA 31326-3119
(912) 547-1643
(912) 754-6137
Mailing address
519 RALPH RAHN RD, RINCON, GA 31326-3119
(912) 547-1643
(912) 754-6137
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP001788
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10034311
AMERIGROUP
GA
01
—
340365
WELLCARE
GA
Enumeration date
11/12/2006
Last updated
07/08/2007
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