MEDICARE: TERRI H. COHEN DBA SPEECH AND LANGUAGE SERVICES

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	261QH0700X	Hearing and Speech Clinic/Center	SLP001587	GA

General Provider Information

NPI Number	:	1821469099
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TERRI H. COHEN DBA SPEECH AND LANGUAGE SERVICES

Provider Business Mailing Address
First Line	:	11050 CRABAPPLE RD
Second Line	:	BLDG D SUITE 115-A
City	:	ROSWELL
State	:	GA
Zip	:	30075-2489
Country	:	US
Telephone Number	:	770-642-0670
Fax Number	:

Provider Business Practice Location Address
First Line	:	1442 DRESDEN DR NE
Second Line	:	UNIT 258
City	:	BROOKHAVEN
State	:	GA
Zip	:	30319-3590
Country	:	US
Telephone Number	:	770-642-0670
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	MS. TERRI HASKINS COHEN
Credential	:	MS CCC-SLP
Telephone Number	:	770-642-0670

Provider Enumeration Date	:	10/14/2015
Last Update Date	:	11/18/2015

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