Provider Demographics
NPI:1346929387
Name:ALOHA SWIM AND SPEECH THERAPY
Entity Type:Organization
Organization Name:ALOHA SWIM AND SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGITS/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLORY
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:706-741-3506
Mailing Address - Street 1:229 UPPER COVE RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:GA
Mailing Address - Zip Code:30293-3906
Mailing Address - Country:US
Mailing Address - Phone:706-741-3506
Mailing Address - Fax:
Practice Address - Street 1:229 UPPER COVE RD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:GA
Practice Address - Zip Code:30293-3906
Practice Address - Country:US
Practice Address - Phone:706-741-3506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty