Healthcare Provider Details

I. General information

NPI: 1730652090
Provider Name (Legal Business Name): DISCOVERY SPEECH THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2019
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 JAMES I HARRISON JR PKWY E STE 200
TUSCALOOSA AL
35405-2651
US

IV. Provider business mailing address

1400 JAMES I HARRISON JR PKWY E STE 200
TUSCALOOSA AL
35405-2651
US

V. Phone/Fax

Practice location:
  • Phone: 205-799-6906
  • Fax: 205-349-1162
Mailing address:
  • Phone: 205-759-1211
  • Fax: 205-349-1162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MALLORY MANNING
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: M.S., CCC-SLP
Phone: 205-799-6906