Provider Demographics
NPI:1043616006
Name:CALDWELL, JOANNA BOONE (MED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:BOONE
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:MED, 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:PO BOX 8068
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-8068
Mailing Address - Country:US
Mailing Address - Phone:706-321-0930
Mailing Address - Fax:
Practice Address - Street 1:705 17TH ST
Practice Address - Street 2:SUITE 407
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-3500
Practice Address - Country:US
Practice Address - Phone:706-321-0930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008725235Z00000X
AL3668235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist