MEDICARE: STUART SPEECH LANGUAGE SOLUTIONS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SLP006235	GA

General Provider Information

NPI Number	:	1033360193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STUART SPEECH LANGUAGE SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	2451 CUMBERLAND PKWY SE STE 3242
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-6136
Country	:	US
Telephone Number	:	770-853-0887
Fax Number	:

Provider Business Practice Location Address
First Line	:	2451 CUMBERLAND PKWY SE STE 3242
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-6136
Country	:	US
Telephone Number	:	770-853-0887
Fax Number	:

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLOGIST
Name	:	JENNIFER SULLIVAN STUART
Credential	:	ED.S, CCC-SLP
Telephone Number	:	770-853-0887

Provider Enumeration Date	:	10/08/2008
Last Update Date	:	10/08/2008

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