Provider Demographics
NPI:1073297826
Name:THE SPEECH LILY LLC
Entity Type:Organization
Organization Name:THE SPEECH LILY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLP
Authorized Official - Prefix:
Authorized Official - First Name:LILY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-624-6492
Mailing Address - Street 1:1136 PONCE DE LEON AVE NE APT 4
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-4575
Mailing Address - Country:US
Mailing Address - Phone:404-624-6492
Mailing Address - Fax:404-806-4377
Practice Address - Street 1:1136 PONCE DE LEON AVE NE APT 4
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306-4575
Practice Address - Country:US
Practice Address - Phone:404-624-6492
Practice Address - Fax:404-806-4377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-12
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty