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General NPI Number Information
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NPI Number | 1164717120
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Entity Type | Organization
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Legal Business Name | ABC SPEECH AND LANGUAGE THERAPY, INC.
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Dates
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Enumeration Date | 06/17/2011
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Last Update Date | 06/17/2011
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Provider Practice Location Address
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Address Line | 4002 HIGHWAY 78 W STE 530-217
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City | SNELLVILLE
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State | GA
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Zip | 30039-7915
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Country | US
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Telephone | 404-931-3901
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Fax | 678-344-0512
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Provider Business Mailing Address
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Address Line | 4002 HIGHWAY 78 W STE 530-217
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City | SNELLVILLE
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State | GA
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Zip | 30039-7915
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Country | US
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Telephone | 404-931-3901
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Fax | 678-344-0512
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LETICIA PAYNE
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Credential | CCC-SLP
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Telephone | 404-931-3901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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