Provider Demographics
NPI:1992210314
Name:GIRARD, MANON (SLP)
Entity type:Individual
Prefix:
First Name:MANON
Middle Name:
Last Name:GIRARD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 WATERSIDE DR SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-2952
Mailing Address - Country:US
Mailing Address - Phone:407-454-4723
Mailing Address - Fax:
Practice Address - Street 1:1000 WATERSIDE DR SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-2952
Practice Address - Country:US
Practice Address - Phone:407-454-4723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-07
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0005492235Z00000X
GASLP011551235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist