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General NPI Number Information
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NPI Number | 1861106189
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Entity Type | Individual
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Provider Name | JOHANNAH DEITZ M. ED., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 01/11/2023
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Last Update Date | 01/11/2023
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Provider Practice Location Address
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Address Line | 566 MURPHY HWY
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City | BLAIRSVILLE
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State | GA
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Zip | 30512-3068
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Country | US
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Telephone | 706-525-5752
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Fax |
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Provider Business Mailing Address
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Address Line | 140 JIMS RD
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City | BLAIRSVILLE
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State | GA
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Zip | 30512-8133
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Country | US
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Telephone | 69-944-0607
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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 | 011207
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License Number State | GA
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