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General NPI Number Information
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NPI Number | 1861632879
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Entity Type | Organization
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Legal Business Name | SPEECH PATHOLOGY SERVICES, INC,
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Dates
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Enumeration Date | 03/03/2009
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Last Update Date | 03/03/2009
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Provider Practice Location Address
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Address Line | 750 HAMMOND DR NE BUILDING 4, SUITE 100
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City | ATLANTA
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State | GA
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Zip | 30328-5532
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Country | US
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Telephone | 404-459-9192
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Fax | 678-904-6347
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Provider Business Mailing Address
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Address Line | 750 HAMMOND DR NE BUILDING 4, SUITE 100
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City | ATLANTA
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State | GA
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Zip | 30328-5532
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Country | US
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Telephone | 404-459-9192
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Fax | 678-904-6347
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Authorized Official
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Title or Position | PRESIDENT/SPEECH-LANGUAGE PATHOLOGI
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Name | MINDA COHEN
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Credential | M.ED., CCC-SLP
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Telephone | 404-459-9192
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | SLP000637
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License Number State | GA
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