Provider Demographics
NPI:1679248348
Name:TALK-A-BOO PEDIATRIC THERAPEUTIC SERVICES LLC
Entity Type:Organization
Organization Name:TALK-A-BOO PEDIATRIC THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLP
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUGER
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:352-727-1434
Mailing Address - Street 1:PO BOX 2063
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30085-2063
Mailing Address - Country:US
Mailing Address - Phone:352-727-1434
Mailing Address - Fax:
Practice Address - Street 1:612 PARK COLONY DR
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-1662
Practice Address - Country:US
Practice Address - Phone:352-727-1434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty