Healthcare Provider Details

I. General information

NPI: 1932432168
Provider Name (Legal Business Name): MANOR OF SPEAKING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2009
Last Update Date: 09/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 W FORSYTH ST SUITE E
AMERICUS GA
31709-3465
US

IV. Provider business mailing address

511 W FORSYTH ST SUITE E
AMERICUS GA
31709-3465
US

V. Phone/Fax

Practice location:
  • Phone: 229-928-8202
  • Fax: 229-928-8205
Mailing address:
  • Phone: 229-928-8202
  • Fax: 229-928-8205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License NumberSLP006018
License Number StateGA

VIII. Authorized Official

Name: MRS. COURTNEY EDMUNDS JACOBS
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: CCC
Phone: 229-928-8202