Active NPI
Connie Sue Reardon, SLP
- Speech-Language Pathologist
- Gainesville, GA
National Provider Identifier
1417075011
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SLP007416
- Practice address
- 4000 Village View Drive
Gainesville, GA 30506 - Phone
- (678) 450-3030
- NPI assigned
- Mar 26, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SLP007416 | GA | Primary |
Addresses
Primary practice location
4000 Village View Drive
Gainesville, GA 30506
Mailing address
2605 Matlin Way
Buford, GA 30519
Phone (330) 592-6788
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SLP007416 | GA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174867200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1342656000000",
"number": "1417075011",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2605 MATLIN WAY",
"city": "BUFORD",
"state": "GA",
"postal_code": "30519",
"telephone_number": "330-592-6788"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4000 VILLAGE VIEW DRIVE",
"city": "GAINESVILLE",
"state": "GA",
"postal_code": "30506",
"telephone_number": "678-450-3030"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REARDON",
"first_name": "CONNIE",
"middle_name": "SUE",
"credential": "SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-26",
"last_updated": "2012-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "GA",
"license": "SLP007416",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gainesville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.