Provider Demographics
NPI:1407439011
Name:ULTIMATE STUTTERING THERAPY LLC
Entity Type:Organization
Organization Name:ULTIMATE STUTTERING THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:404-491-9306
Mailing Address - Street 1:PO BOX 361265
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30036-1265
Mailing Address - Country:US
Mailing Address - Phone:404-491-9306
Mailing Address - Fax:404-777-9360
Practice Address - Street 1:2095 MANHATTAN PKWY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-2252
Practice Address - Country:US
Practice Address - Phone:404-491-9306
Practice Address - Fax:404-777-9360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty