Healthcare Provider Details

I. General information

NPI: 1093467466
Provider Name (Legal Business Name): SPACE SPEECH THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2022
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 ROCK SPRINGS CIR NE APT 3-1523
ATLANTA GA
30306-2229
US

IV. Provider business mailing address

2897 N DRUID HILLS RD NE STE 531
ATLANTA GA
30329-3924
US

V. Phone/Fax

Practice location:
  • Phone: 404-482-2947
  • Fax:
Mailing address:
  • Phone: 404-482-2947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. KIANA DESIREE HINES
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: PHD., CCC-SLP
Phone: 404-482-2947