Basic Information
| Provider Information | |||||||||
| NPI: | 1447534748 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RANKINS | ||||||||
| FirstName: | JSWANDA | ||||||||
| MiddleName: | VANAE | ||||||||
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| Credential: | M.S. CCC/SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1904 OGLETHORPE DR NE | ||||||||
| Address2: | |||||||||
| City: | BROOKHAVEN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303192794 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6786565336 | ||||||||
| FaxNumber: | 5523286048 | ||||||||
| Practice Location | |||||||||
| Address1: | 1904 OGLETHORPE DR NE | ||||||||
| Address2: | |||||||||
| City: | BROOKHAVEN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303192794 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6786565336 | ||||||||
| FaxNumber: | 8552328604 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2011 | ||||||||
| LastUpdateDate: | 07/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SLP005006 | GA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.