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General NPI Number Information
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NPI Number | 1366730764
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Entity Type | Organization
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Legal Business Name | ATLANTA SPEECH & LANGUAGE THERAPY, LLC
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Dates
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Enumeration Date | 07/19/2011
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Last Update Date | 07/19/2011
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Provider Practice Location Address
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Address Line | 7525 BALL MILL RD
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City | ATLANTA
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State | GA
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Zip | 30350-4405
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Country | US
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Telephone | 404-663-1116
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Fax |
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Provider Business Mailing Address
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Address Line | 7525 BALL MILL RD
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City | ATLANTA
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State | GA
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Zip | 30350-4405
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Country | US
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Telephone | 404-663-1116
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Fax |
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | LAUREN GOMES
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Credential | M.ED. CCC-SLP
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Telephone | 404-663-1116
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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 | SLP007327
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License Number State | GA
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