MEDICARE: THE SPEECH PATH

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	SLP009106	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487011888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE SPEECH PATH

Provider Business Mailing Address
First Line	:	225 WES PARK DR
Second Line	:
City	:	PERRY
State	:	GA
Zip	:	31069-4829
Country	:	US
Telephone Number	:	478-987-1610
Fax Number	:	973-965-4580

Provider Business Practice Location Address
First Line	:	225 WES PARK DR
Second Line	:
City	:	PERRY
State	:	GA
Zip	:	31069-4829
Country	:	US
Telephone Number	:	478-987-1610
Fax Number	:	973-965-4580

Authorized Official
Title or Position	:	CO-OWNER
Name	:	KATE LEWIS
Credential	:
Telephone Number	:	478-987-1610

Provider Enumeration Date	:	01/15/2016
Last Update Date	:	01/15/2016

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Directions to “THE SPEECH PATH ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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