Individual
REBECCA PRUITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
4319 S LEE ST, BUFORD, GA 30518-5747
(678) 288-9770
Mailing address
4319 S LEE ST, BUFORD, GA 30518-5747
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP009408
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SLP009408
GEORGIA SECRETARY OF STATE
GA
Enumeration date
08/26/2016
Last updated
08/26/2016
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