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? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Single Specialty |