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General NPI Number Information
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NPI Number | 1740146935
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Entity Type | Organization
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Legal Business Name | SPEECH LANGUAGE AND COGNITIVE REHABILITATION LLC
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Dates
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Enumeration Date | 12/31/2025
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Last Update Date | 12/31/2025
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Provider Practice Location Address
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Address Line | 1764 BOB WHITE LANE
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City | CONYERS
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State | GA
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Zip | 30013
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Country | US
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Telephone | 470-223-1838
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Fax |
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Provider Business Mailing Address
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Address Line | 1820 HIGHWAY 20 SE STE 114
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City | CONYERS
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State | GA
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Zip | 30013-2076
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Country | US
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Telephone | 470-223-1838
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | SYNEBIA MARTIN
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Credential |
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Telephone | 678-663-2359
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number |
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License Number State |
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Taxonomy #2
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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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