Gordon, Jenny Lyle
Gordon, Jenny Lyle is an sole proprietor health care provider with primary practice located at 121B Lee St , Carrollton GA 30117-3314. She recently has only one registered license in Speech, Language and Hearing Service Providers / Speech-Language Pathologist, which is considered as her primary health care specialty. Gordon, Jenny Lyle can be contacted via phone (770) 830-8622.Contact Information
Primary practice address
121B Lee St
Carrollton GA 30117-3314
Phone: (770) 830-8622
Fax: (770) 832-9031
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Speech, Language and Hearing Service Providers / Speech-Language Pathologist | 235Z00000X | SLP006776 | Georgia |
Profile Details
| NPI number | 1710161179 |
|---|---|
| LBN Legal business name | Gordon, Jenny Lyle |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Dec 20th, 2007 |
| Last updated | May 15th, 2008 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1710161179 | NPPES |
| Georgia | MEDICAID | 126664544A |
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