MEDICARE: SIMPLY SPEECH OF GEORGIA

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

General Provider Information

NPI Number	:	1912106055
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMPLY SPEECH OF GEORGIA

Provider Business Mailing Address
First Line	:	3295 LAKE SEMINOLE PL
Second Line	:
City	:	BUFORD
State	:	GA
Zip	:	30519-3781
Country	:	US
Telephone Number	:	770-294-5472
Fax Number	:

Provider Business Practice Location Address
First Line	:	3295 LAKE SEMINOLE PL
Second Line	:
City	:	BUFORD
State	:	GA
Zip	:	30519-3781
Country	:	US
Telephone Number	:	770-294-5472
Fax Number	:

Authorized Official
Title or Position	:	SPEECH PATHOLOGIST/PRESIDENT
Name	:	MRS. REBEKAH O'CONNOR
Credential	:	MS,CCC,SLP
Telephone Number	:	770-294-5472

Provider Enumeration Date	:	07/17/2007
Last Update Date	:	07/17/2007

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Directions to “SIMPLY SPEECH OF GEORGIA ” Practice Location

Language	Start Address	Practice Location

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