Provider Demographics
NPI:1538236252
Name:UPSHAW, HELEN P (CCC-SLP)
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:P
Last Name:UPSHAW
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 1:1282 COBBLEMILL WAY NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-2899
Mailing Address - Country:US
Mailing Address - Phone:770-590-7977
Mailing Address - Fax:
Practice Address - Street 1:413 INDIAN HILLS TRL
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4055
Practice Address - Country:US
Practice Address - Phone:770-973-3466
Practice Address - Fax:770-977-1582
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP001206235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist