Provider Demographics
NPI:1316402803
Name:COBB SPEECH & LANGUAGE SERVICES
Entity Type:Organization
Organization Name:COBB SPEECH & LANGUAGE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER, SLP
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:404-384-3650
Mailing Address - Street 1:220 OLD HAMILTON RD NW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-1628
Mailing Address - Country:US
Mailing Address - Phone:404-384-3650
Mailing Address - Fax:
Practice Address - Street 1:220 OLD HAMILTON RD NW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-1628
Practice Address - Country:US
Practice Address - Phone:404-384-3650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003207745AMedicaid