Provider Demographics
NPI:1558077677
Name:SCOOP SPEECH, LLC
Entity Type:Organization
Organization Name:SCOOP SPEECH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RODOLFO JAN MICHAEL
Authorized Official - Middle Name:LINGAD
Authorized Official - Last Name:ZORRILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-778-2193
Mailing Address - Street 1:3295 RIVER EXCHANGE DR STE 170
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-4220
Mailing Address - Country:US
Mailing Address - Phone:404-500-8264
Mailing Address - Fax:678-691-2882
Practice Address - Street 1:3295 RIVER EXCHANGE DR STE 170
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-4220
Practice Address - Country:US
Practice Address - Phone:404-500-8264
Practice Address - Fax:678-691-2882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-24
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty