MEDICARE: MANOR OF SPEAKING, 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	261QH0700X	Hearing and Speech Clinic/Center	SLP006018	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
2	1205012911	OTHER	GA	INDIVIDUAL NPI

General Provider Information

NPI Number	:	1932432168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANOR OF SPEAKING, LLC

Provider Business Mailing Address
First Line	:	511 W FORSYTH ST
Second Line	:	SUITE E
City	:	AMERICUS
State	:	GA
Zip	:	31709-3465
Country	:	US
Telephone Number	:	229-928-8202
Fax Number	:	229-928-8205

Provider Business Practice Location Address
First Line	:	511 W FORSYTH ST
Second Line	:	SUITE E
City	:	AMERICUS
State	:	GA
Zip	:	31709-3465
Country	:	US
Telephone Number	:	229-928-8202
Fax Number	:	229-928-8205

Authorized Official
Title or Position	:	SPEECH-LANGUAGE PATHOLOGIST
Name	:	MRS. COURTNEY EDMUNDS JACOBS
Credential	:	CCC
Telephone Number	:	229-928-8202

Provider Enumeration Date	:	09/04/2009
Last Update Date	:	09/09/2009

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Directions to “MANOR OF SPEAKING, LLC ” Practice Location

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