Provider Demographics
NPI:1447534748
Name:RANKINS, JSWANDA VANAE (MS CCC/SLP)
Entity type:Individual
Prefix:
First Name:JSWANDA
Middle Name:VANAE
Last Name:RANKINS
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 OGLETHORPE DR NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-2794
Mailing Address - Country:US
Mailing Address - Phone:678-656-5336
Mailing Address - Fax:552-328-6048
Practice Address - Street 1:1904 OGLETHORPE DR NE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-2794
Practice Address - Country:US
Practice Address - Phone:678-656-5336
Practice Address - Fax:855-232-8604
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005006235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist