Healthcare Provider Details

I. General information

NPI: 1780506840
Provider Name (Legal Business Name): SPEECH THERAPY CONNECTION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 CREEKVIEW BLVD
COVINGTON GA
30016-7693
US

IV. Provider business mailing address

270 CREEKVIEW BLVD
COVINGTON GA
30016-7693
US

V. Phone/Fax

Practice location:
  • Phone: 404-434-9595
  • Fax: 404-481-2455
Mailing address:
  • Phone: 404-434-9595
  • Fax: 404-481-2455

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: KIMBERLY D. JACKSON
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: M.S., CCC-SLP
Phone: 404-434-9595