Provider Demographics
NPI:1689739518
Name:MS LILLYS SINGING AND PIANO LESSONS AND SPEECH THERAPY, LLC
Entity Type:Organization
Organization Name:MS LILLYS SINGING AND PIANO LESSONS AND SPEECH THERAPY, LLC
Other - Org Name:LILLIAN WAYNE BUCK SPEECH LANGUAGE PATHOLOGY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:WAYNE BUCK
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC SLP
Authorized Official - Phone:706-839-1770
Mailing Address - Street 1:3980 HIGHWAY 115
Mailing Address - Street 2:
Mailing Address - City:DEMOREST
Mailing Address - State:GA
Mailing Address - Zip Code:30535-3143
Mailing Address - Country:US
Mailing Address - Phone:706-839-1770
Mailing Address - Fax:706-839-1779
Practice Address - Street 1:3980 HIGHWAY 115
Practice Address - Street 2:
Practice Address - City:DEMOREST
Practice Address - State:GA
Practice Address - Zip Code:30535-3143
Practice Address - Country:US
Practice Address - Phone:706-839-1770
Practice Address - Fax:706-839-1779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006182235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty