Provider Demographics
NPI:1861730525
Name:SUMMERVILLE MCNEILL, TAUNISHA DAWN (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:TAUNISHA
Middle Name:DAWN
Last Name:SUMMERVILLE MCNEILL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2331 GREENSIDE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-8249
Mailing Address - Country:US
Mailing Address - Phone:770-941-6770
Mailing Address - Fax:678-317-0890
Practice Address - Street 1:2331 GREENSIDE DR
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-8249
Practice Address - Country:US
Practice Address - Phone:770-941-6770
Practice Address - Fax:678-317-0890
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005974235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist