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General NPI Number Information
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NPI Number | 1538315874
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Entity Type | Organization
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Legal Business Name | SPEECH BREAKTHROUGH, LLC
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Dates
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Enumeration Date | 08/18/2008
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Last Update Date | 08/18/2008
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Provider Practice Location Address
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Address Line | 157 WINDCROFT LN NW
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City | ACWORTH
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State | GA
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Zip | 30101-3767
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Country | US
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Telephone | 770-516-0156
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Fax | 770-516-0156
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Provider Business Mailing Address
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Address Line | PO BOX 148
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City | ACWORTH
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State | GA
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Zip | 30101-0148
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Country | US
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Telephone | 770-516-0156
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Fax | 770-516-0156
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Authorized Official
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Title or Position | SPEECH PATHOLOGIST
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Name | MS. DEDRA HILLSMAN
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Credential | M.S. CCC-SLP
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Telephone | 770-516-0156
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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 | 449440
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License Number State | GA
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