Provider Demographics
NPI:1194841148
Name:SPEEKS, EMELDA LOUISE
Entity Type:Individual
Prefix:
First Name:EMELDA
Middle Name:LOUISE
Last Name:SPEEKS
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:EMELDA
Other - Middle Name:L
Other - Last Name:SPEEKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AUD,CCC,SP A
Mailing Address - Street 1:414 HOMEPLACE DR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7701
Mailing Address - Country:US
Mailing Address - Phone:770-367-3677
Mailing Address - Fax:770-506-0174
Practice Address - Street 1:414 HOMEPLACE DR
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7701
Practice Address - Country:US
Practice Address - Phone:770-367-3677
Practice Address - Fax:770-506-0174
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA529231H00000X, 235Z00000X
GASLP004304235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist