Provider Demographics
NPI:1518395649
Name:A CHANCE TO SMILE, LLC
Entity Type:Organization
Organization Name:A CHANCE TO SMILE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:404-590-1237
Mailing Address - Street 1:805 GLYNN ST S
Mailing Address - Street 2:STE 127-193
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-2000
Mailing Address - Country:US
Mailing Address - Phone:404-590-1237
Mailing Address - Fax:
Practice Address - Street 1:805 GLYNN ST S
Practice Address - Street 2:STE 127-193
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-2000
Practice Address - Country:US
Practice Address - Phone:404-590-1237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2015-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007158235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty