1861632879 NPI number — SPEECH PATHOLOGY SERVICES, INC,

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861632879 NPI number — SPEECH PATHOLOGY SERVICES, INC,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPEECH PATHOLOGY SERVICES, INC,
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861632879
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
750 HAMMOND DR NE
Provider Second Line Business Mailing Address:
BUILDING 4, SUITE 100
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30328-5532
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-459-9192
Provider Business Mailing Address Fax Number:
678-904-6347

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
750 HAMMOND DR NE
Provider Second Line Business Practice Location Address:
BUILDING 4, SUITE 100
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30328-5532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-459-9192
Provider Business Practice Location Address Fax Number:
678-904-6347
Provider Enumeration Date:
03/03/2009

Additional Information

Authorized Official

Authorized Official Last Name:
COHEN
Authorized Official First Name:
MINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/SPEECH-LANGUAGE PATHOLOGI
Authorized Official Telephone Number:
404-459-9192

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  SLP000637 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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