Provider Demographics
NPI:1164113643
Name:FOREVER ARTICULATE SPEECH THERAPY
Entity Type:Organization
Organization Name:FOREVER ARTICULATE SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARAY
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:MED CCC-SLP
Authorized Official - Phone:678-697-5093
Mailing Address - Street 1:365 FAULKNER ST
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-2819
Mailing Address - Country:US
Mailing Address - Phone:678-697-5093
Mailing Address - Fax:
Practice Address - Street 1:365 FAULKNER ST
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-2819
Practice Address - Country:US
Practice Address - Phone:678-697-5093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-16
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty