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General NPI Number Information
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NPI Number | 1073041919
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Entity Type | Organization
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Legal Business Name | GOLDEN SPEECH THERAPY, INC
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Dates
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Enumeration Date | 05/23/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 117 3RD ST E
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City | TIFTON
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State | GA
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Zip | 31794
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Country | US
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Telephone | 229-402-7188
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Fax | 229-329-4532
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Provider Business Mailing Address
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Address Line | PO BOX 7662
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City | TIFTON
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State | GA
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Zip | 31793-7662
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Country | US
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Telephone | 478-455-1171
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Fax |
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST/CEO
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Name | REBECCA GOLDEN WALDROP
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Credential | M.ED CCC-SLP
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Telephone | 478-455-1171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | SLP008926
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License Number State | GA
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