Provider Demographics
NPI:1306204946
Name:COMMUNICATION STATION D.A.S
Entity Type:Organization
Organization Name:COMMUNICATION STATION D.A.S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGOWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-793-0624
Mailing Address - Street 1:3645 MARKETPLACE BLVD
Mailing Address - Street 2:SUITE 130-635
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-5747
Mailing Address - Country:US
Mailing Address - Phone:678-793-0624
Mailing Address - Fax:184-472-2701
Practice Address - Street 1:3645 MARKETPLACE BLVD
Practice Address - Street 2:SUITE 130-635
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-5747
Practice Address - Country:US
Practice Address - Phone:678-793-0624
Practice Address - Fax:184-472-2701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-10
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008010235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty