Healthcare Provider Details

I. General information

NPI: 1720421399
Provider Name (Legal Business Name): SPEECH LANGUAGE AND BEYOND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2013
Last Update Date: 04/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 DIVINE DR
ALBANY GA
31721-9547
US

IV. Provider business mailing address

514 DIVINE DR
ALBANY GA
31721-9547
US

V. Phone/Fax

Practice location:
  • Phone: 229-638-0627
  • Fax: 229-496-5277
Mailing address:
  • Phone: 229-638-0627
  • Fax: 229-496-5277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberSLP007125
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberSLP007125
License Number StateGA

VIII. Authorized Official

Name: ASHELY SELLERS
Title or Position: OWNER-OPERATOR
Credential: CCC-SLP
Phone: 229-638-0627