Provider Demographics
NPI:1003324609
Name:PROCOM SPEECH-LANGUAGE SERVICES
Entity Type:Organization
Organization Name:PROCOM SPEECH-LANGUAGE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SLP
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:913-702-4575
Mailing Address - Street 1:3503 PIEDMONT LAKE RD
Mailing Address - Street 2:
Mailing Address - City:PINE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:31822-3566
Mailing Address - Country:US
Mailing Address - Phone:913-702-4575
Mailing Address - Fax:
Practice Address - Street 1:3645 GENTIAN BLVD STE 3B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-5688
Practice Address - Country:US
Practice Address - Phone:706-457-3883
Practice Address - Fax:706-243-4985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-17
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006148235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty