Provider Demographics
NPI:1013179100
Name:COMMUNICATION DYNAMICS
Entity Type:Organization
Organization Name:COMMUNICATION DYNAMICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCANDRETT
Authorized Official - Suffix:
Authorized Official - Credentials:CCC SLP
Authorized Official - Phone:478-714-3807
Mailing Address - Street 1:236 KIMMERIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31220-2672
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:236 KIMMERIDGE DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31220-2672
Practice Address - Country:US
Practice Address - Phone:478-714-3807
Practice Address - Fax:478-475-4196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005793235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty