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General NPI Number Information
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NPI Number | 1124476791
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Entity Type | Individual
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Provider Name | ROSALINDA WONG
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Gender | Female
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Dates
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Enumeration Date | 05/24/2016
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Last Update Date | 09/13/2016
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Provider Practice Location Address
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Address Line | 545 OLD NORCROSS RD STE 100
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-3390
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Country | US
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Telephone | 678-377-2833
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Fax |
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Provider Business Mailing Address
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Address Line | 1003 ENSIGN PEAK CT
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-3482
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Country | US
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Telephone | 678-490-1694
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SLP009243
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License Number State | GA
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