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General NPI Number Information
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NPI Number | 1831053511
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Entity Type | Individual
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Provider Name | JAQUELINE SOFIA CEBALLOS
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Gender | Female
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Dates
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Enumeration Date | 12/16/2025
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 1130 HURRICANE SHOALS RD NE STE 2300
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-4871
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Country | US
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Telephone | 470-323-6711
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Fax | 478-575-2359
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Provider Business Mailing Address
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Address Line | 625 CLEARWATER PL
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-6834
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Country | US
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Telephone | 404-944-2477
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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 | SLPA000601
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License Number State | GA
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