Provider Demographics
NPI:1508248618
Name:SPEECHCARE PEDIATRICS, LLC
Entity Type:Organization
Organization Name:SPEECHCARE PEDIATRICS, LLC
Other - Org Name:SPEECHCARE INSPIRATIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCC-SLP
Authorized Official - Phone:404-680-3919
Mailing Address - Street 1:893 PIEDMONT AVE NE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-4174
Mailing Address - Country:US
Mailing Address - Phone:404-680-3919
Mailing Address - Fax:
Practice Address - Street 1:893 PIEDMONT AVE NE
Practice Address - Street 2:SUITE 11
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-4174
Practice Address - Country:US
Practice Address - Phone:404-680-3919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP0084772252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003149495AMedicaid