Provider Demographics
NPI:1477812600
Name:DYNAMIC SPEECH & LANGUAGE SERVICES, INC
Entity Type:Organization
Organization Name:DYNAMIC SPEECH & LANGUAGE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRESHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-644-9188
Mailing Address - Street 1:3695F CASCADE RD SW # 2292
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-2105
Mailing Address - Country:US
Mailing Address - Phone:678-644-9188
Mailing Address - Fax:404-254-5474
Practice Address - Street 1:3695F CASCADE RD SW # 2292
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2105
Practice Address - Country:US
Practice Address - Phone:678-644-9188
Practice Address - Fax:404-254-5474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005692252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA371023031EMedicaid