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General NPI Number Information
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NPI Number | 1568453595
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Entity Type | Individual
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Provider Name | IDA RACHERYL LENOIR-MONROE EDS,CCC,SLP
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Gender | Female
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Dates
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Enumeration Date | 10/31/2005
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Last Update Date | 03/28/2012
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Provider Practice Location Address
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Address Line | 1505 AUGHTON CT
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City | CONYERS
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State | GA
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Zip | 30013-7410
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Country | US
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Telephone | 770-679-0909
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Fax |
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Provider Business Mailing Address
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Address Line | 1505 AUGHTON CT
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City | CONYERS
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State | GA
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Zip | 30013-7410
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Country | US
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Telephone | 770-679-0909
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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 | S3007
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License Number State | MS
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