Individual
ANDREA BOUTWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ST
Contact information
Practice address
901 18TH ST E, TIFTON, GA 31794-3648
(229) 353-3347
(229) 353-7722
Mailing address
901 18TH ST E, TIFTON, GA 31794-3648
(229) 353-3347
(229) 353-7722
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP006592
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SLP006592
LICENSE NUMBER
GA
Enumeration date
03/30/2007
Last updated
07/08/2007
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