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General NPI Number Information
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NPI Number | 1649192436
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Entity Type | Individual
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Provider Name | RAQUELLE R SOUTHARD SLP
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Gender | Female
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Dates
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Enumeration Date | 07/27/2026
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Last Update Date | 07/27/2026
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Provider Practice Location Address
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Address Line | 5820 VETERANS PKWY STE 210
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City | COLUMBUS
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State | GA
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Zip | 31904-3465
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Country | US
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Telephone | 706-641-7313
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Fax |
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Provider Business Mailing Address
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Address Line | 3071 WILLIAMS RD APT 165
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City | COLUMBUS
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State | GA
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Zip | 31909-5688
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Country | US
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Telephone | 318-664-3613
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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 | SLP014236
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License Number State | GA
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