Provider Demographics
NPI:1306026497
Name:THE SPEECH & SWALLOWING CLINIC, LLC
Entity Type:Organization
Organization Name:THE SPEECH & SWALLOWING CLINIC, LLC
Other - Org Name:THE THERAPY TREE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-331-0846
Mailing Address - Street 1:118 PEARL AVE N
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-4632
Mailing Address - Country:US
Mailing Address - Phone:912-331-0846
Mailing Address - Fax:678-792-4894
Practice Address - Street 1:618 BOWENS MILL RD SW
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-3926
Practice Address - Country:US
Practice Address - Phone:912-331-0846
Practice Address - Fax:678-792-4894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004462261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000813106RMedicaid
GA003104600CMedicaid
GA003116223HMedicaid
GA003104600AMedicaid
GA003104600BMedicaid
GA003171926BMedicaid
GA003116223DMedicaid
GA000813106HMedicaid
GA000813106OMedicaid
GA003116223AMedicaid