Provider Demographics
NPI:1083475560
Name:FORSYTH SPEECH THERAPY LLC
Entity Type:Organization
Organization Name:FORSYTH SPEECH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SLP
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:P
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:478-955-1204
Mailing Address - Street 1:103 KYNDALL LN
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:GA
Mailing Address - Zip Code:31029-8762
Mailing Address - Country:US
Mailing Address - Phone:478-955-1204
Mailing Address - Fax:
Practice Address - Street 1:57 S LEE ST
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:GA
Practice Address - Zip Code:31029-1700
Practice Address - Country:US
Practice Address - Phone:478-955-1204
Practice Address - Fax:478-202-9941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech