Provider Demographics
NPI:1730224205
Name:SELLERS, DEEDEE B (SLP)
Entity type:Individual
Prefix:
First Name:DEEDEE
Middle Name:B
Last Name:SELLERS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:DEEDEE
Other - Middle Name:J
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:3256 N VALDOSTA RD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1778
Mailing Address - Country:US
Mailing Address - Phone:229-560-6944
Mailing Address - Fax:888-450-0379
Practice Address - Street 1:3256 N VALDOSTA RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1778
Practice Address - Country:US
Practice Address - Phone:229-560-6944
Practice Address - Fax:888-450-0379
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006480235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GASLP006480OtherLICENSE NUMBER