Provider Demographics
NPI:1578025953
Name:FOUNDATIONS PEDIATRIC SPEECH THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:FOUNDATIONS PEDIATRIC SPEECH THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:D
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:470-636-0710
Mailing Address - Street 1:3556 BRIDLE BROOK DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30011-2381
Mailing Address - Country:US
Mailing Address - Phone:470-636-0710
Mailing Address - Fax:
Practice Address - Street 1:2700 BRASELTON HWY STE 3
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-3263
Practice Address - Country:US
Practice Address - Phone:470-636-0710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty