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General NPI Number Information
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NPI Number | 1609764448
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Entity Type | Organization
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Legal Business Name | MODEL & ROOT SPEECH CO., LLC
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Dates
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Enumeration Date | 06/27/2025
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Last Update Date | 08/11/2025
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Provider Practice Location Address
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Address Line | 2629 IRENE CIR
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City | DULUTH
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State | GA
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Zip | 30096-4147
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Country | US
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Telephone | 919-802-4871
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Fax |
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Provider Business Mailing Address
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Address Line | 2629 IRENE CIR
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City | DULUTH
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State | GA
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Zip | 30096-4147
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Country | US
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Telephone | 919-802-4871
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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 | DANIELLE BROWN
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Credential |
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Telephone | 919-802-4871
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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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