Provider Demographics
NPI:1164717120
Name:ABC SPEECH AND LANGUAGE THERAPY, INC.
Entity Type:Organization
Organization Name:ABC SPEECH AND LANGUAGE THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LETICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:404-931-3901
Mailing Address - Street 1:4002 HIGHWAY 78 W STE 530-217
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-7915
Mailing Address - Country:US
Mailing Address - Phone:404-931-3901
Mailing Address - Fax:678-344-0512
Practice Address - Street 1:4002 HIGHWAY 78 W STE 530-217
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-7915
Practice Address - Country:US
Practice Address - Phone:404-931-3901
Practice Address - Fax:678-344-0512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003109679AMedicaid