Healthcare Provider Details

I. General information

NPI: 1922929793
Provider Name (Legal Business Name): BRIDGE SPEECH LANGUAGE PATHOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 JACKSON ST NE APT 7204
ATLANTA GA
30312-7901
US

IV. Provider business mailing address

180 JACKSON ST NE APT 7204
ATLANTA GA
30312-7901
US

V. Phone/Fax

Practice location:
  • Phone: 470-576-2829
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: ASHLEY COLON
Title or Position: OWNER
Credential:
Phone: 470-576-2829