MEDICARE: SPEECH SOUNDS, LLC

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	261QH0700X	Hearing and Speech Clinic/Center		GA

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	:	1558862748
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPEECH SOUNDS, LLC

Provider Business Mailing Address
First Line	:	1459 FENWICK DR SW
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-2783
Country	:	US
Telephone Number	:	678-471-5734
Fax Number	:

Provider Business Practice Location Address
First Line	:	1459 FENWICK DR SW
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-2783
Country	:	US
Telephone Number	:	678-471-5734
Fax Number	:

Authorized Official
Title or Position	:	SPEECH PATHOLOGIST
Name	:	ROGER A CLECKLEY
Credential	:	MA, CCC-SLP
Telephone Number	:	678-471-5734

Provider Enumeration Date	:	02/23/2018
Last Update Date	:	02/23/2018

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Directions to “SPEECH SOUNDS, LLC ” Practice Location

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