Provider Demographics
NPI:1568970457
Name:HEART SONG SPEECH AND LANGUAGE SERVICES LLC
Entity Type:Organization
Organization Name:HEART SONG SPEECH AND LANGUAGE SERVICES LLC
Other - Org Name:LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:WORTHINGTON
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MCD, CCC-SLP
Authorized Official - Phone:678-621-9381
Mailing Address - Street 1:2746 CREEKS EDGE LN
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-8665
Mailing Address - Country:US
Mailing Address - Phone:678-621-9381
Mailing Address - Fax:
Practice Address - Street 1:8402 LITTLE JOHN JCT
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-1066
Practice Address - Country:US
Practice Address - Phone:678-621-9381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-14
Last Update Date:2018-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12125261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech