Healthcare Provider Details

I. General information

NPI: 1336054535
Provider Name (Legal Business Name): LAKE COUNTRY LANGUAGE AND LITERACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 ALEXANDER LAKES DR
EATONTON GA
31024-8051
US

IV. Provider business mailing address

147 ALEXANDER LAKES DR
EATONTON GA
31024-8051
US

V. Phone/Fax

Practice location:
  • Phone: 678-469-8421
  • Fax:
Mailing address:
  • Phone: 678-469-8421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. STACEY GOTHARD
Title or Position: OWNER
Credential: M.ED., CCC-SLP
Phone: 678-469-8421