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General NPI Number Information
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NPI Number | 1558862748
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Entity Type | Organization
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Legal Business Name | SPEECH SOUNDS, LLC
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Dates
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Enumeration Date | 02/23/2018
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Last Update Date | 02/23/2018
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Provider Practice Location Address
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Address Line | 1459 FENWICK DR SW
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City | MARIETTA
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State | GA
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Zip | 30064-2783
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Country | US
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Telephone | 678-471-5734
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Fax |
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Provider Business Mailing Address
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Address Line | 1459 FENWICK DR SW
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City | MARIETTA
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State | GA
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Zip | 30064-2783
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Country | US
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Telephone | 678-471-5734
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Fax |
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Authorized Official
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Title or Position | SPEECH PATHOLOGIST
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Name | ROGER A CLECKLEY
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Credential | MA, CCC-SLP
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Telephone | 678-471-5734
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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 |
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License Number State | GA
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