Provider Demographics
NPI:1194401711
Name:SEABROOKS, DYNESE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:DYNESE
Middle Name:
Last Name:SEABROOKS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 HAYDENS CT
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-2126
Mailing Address - Country:US
Mailing Address - Phone:912-755-5939
Mailing Address - Fax:
Practice Address - Street 1:3 HAYDENS CT
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-2126
Practice Address - Country:US
Practice Address - Phone:912-755-5939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP012203235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist