Stacey E Johlman, SP
Individual provider Active NPI Speech-Language Pathologist · Rome, GA
NPI 1891965323 · NPPES record last updated Jun 4, 2019
Key facts
- NPI
- 1891965323
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- SLP010130 (GA)
- Practice address
- 212 W 3Rd St SW
Rome, GA 30165-2802 - Phone
- (706) 295-4242
- NPI assigned
- Mar 12, 2008
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8834 | CA | MD | Acupuncturist |
| SLP010130 | GA | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advance Rehabilitation for Kids of Gordon County, Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 8834 | CA | |
| Speech-Language Pathologist | 235Z00000X | SLP010130 | GA | Yes |
Addresses
Primary practice location
212 W 3Rd St SW
Rome, GA 30165-2802
Mailing address
365 S Industrial Blvd
Calhoun, GA 30701-3075
Phone (706) 624-3000
Other practice location 1
365 S Industrial Blvd
Calhoun, GA 30701
Phone (706) 624-3000
Other providers in Rome, GA
- Catrin Jensen
- Benjamin Chase Jessie
- Mark A Jester
- Phyllis J Jeter
- Jill Marie Jewett
- John Azar-Dickens, PH.D.,PC
- John J. Beninato, D.D.S., P.C.
- John Marshall Jenkins PHD LLC
- Alexis Johnson
- Chandler Elizabeth Johnson
All providers in Rome, GA · Speech-Language Pathologist in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 4, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.