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General NPI Number Information
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NPI Number | 1740137199
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Entity Type | Individual
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Provider Name | KHALIA REANNE DADE
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Gender | Female
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Dates
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Enumeration Date | 03/13/2026
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Last Update Date | 03/13/2026
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Provider Practice Location Address
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Address Line | 2507 CHURCHILL DR
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City | VALDOSTA
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State | GA
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Zip | 31602-2547
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Country | US
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Telephone | 951-807-4723
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Fax |
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Provider Business Mailing Address
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Address Line | 2507 CHURCHILL DR
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City | VALDOSTA
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State | GA
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Zip | 31602-2547
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Country | US
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Telephone |
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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 | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | 5347
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License Number State | CA
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