MEDICARE: THERAPEUTIC SPEECH AND LANGUAGE SERVICES INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SLP005950	GA

General Provider Information

NPI Number	:	1538592530
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERAPEUTIC SPEECH AND LANGUAGE SERVICES INC.

Provider Business Mailing Address
First Line	:	302 PONCE DE LEON PL
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30030-5122
Country	:	US
Telephone Number	:	404-932-0696
Fax Number	:	404-973-0756

Provider Business Practice Location Address
First Line	:	390 17TH ST NW
Second Line	:	#3063
City	:	ATLANTA
State	:	GA
Zip	:	30363-2000
Country	:	US
Telephone Number	:	404-932-0696
Fax Number	:	404-973-0756

Authorized Official
Title or Position	:	CEO
Name	:	MS. KIMBERLY YON
Credential	:	M.S. CCC-SLP
Telephone Number	:	404-932-0696

Provider Enumeration Date	:	08/13/2013
Last Update Date	:	03/03/2020

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Directions to “THERAPEUTIC SPEECH AND LANGUAGE SERVICES INC. ” Practice Location

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