MEDICARE: GIFTED INTEGRATIVE SPEECH THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225100000X	Physical Therapist
2	103K00000X	Behavior Analyst
3	225X00000X	Occupational Therapist
4	235Z00000X	Speech-Language Pathologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023514197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIFTED INTEGRATIVE SPEECH THERAPY

Provider Business Mailing Address
First Line	:	920 DANNON VW SW STE 3203
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-2161
Country	:	US
Telephone Number	:	678-948-6632
Fax Number	:	888-972-3946

Provider Business Practice Location Address
First Line	:	920 DANNON VW SW STE 3203
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-2161
Country	:	US
Telephone Number	:	678-948-6632
Fax Number	:	888-972-3946

Authorized Official
Title or Position	:	OWNER
Name	:	JASMINE PHILPOT-SLOCUM
Credential	:	CCC-SLP
Telephone Number	:	678-948-6632

Provider Enumeration Date	:	04/05/2018
Last Update Date	:	06/17/2026

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Directions to “GIFTED INTEGRATIVE SPEECH THERAPY ” Practice Location

Language	Start Address	Practice Location

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