MEDICARE: ABLE SPEECH AND FEEDING 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	133VN1004X	Pediatric Nutrition Registered Dietitian
2	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1841997806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABLE SPEECH AND FEEDING LLC

Provider Business Mailing Address
First Line	:	3816 CLINE DR SE
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30082-3115
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4405 NORTHSIDE PKWY NW STE 120A
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-5202
Country	:	US
Telephone Number	:	678-910-0401
Fax Number	:

Authorized Official
Title or Position	:	OWNER, SPEECH-LANGUAGE PATHOLOGIST
Name	:	MRS. JESSICA BARRETT
Credential	:	CCC-SLP
Telephone Number	:	678-910-0401

Provider Enumeration Date	:	02/10/2023
Last Update Date	:	02/10/2023

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Directions to “ABLE SPEECH AND FEEDING LLC ” Practice Location

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