Provider Demographics
NPI:1689850398
Name:SPEECH AND LANGUAGE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:SPEECH AND LANGUAGE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:CARREKER
Authorized Official - Last Name:DAUGHTRY
Authorized Official - Suffix:
Authorized Official - Credentials:MCD,CCC-SLP
Authorized Official - Phone:478-397-7886
Mailing Address - Street 1:105 TAMIE CT
Mailing Address - Street 2:
Mailing Address - City:KATHLEEN
Mailing Address - State:GA
Mailing Address - Zip Code:31047-2222
Mailing Address - Country:US
Mailing Address - Phone:478-397-7886
Mailing Address - Fax:478-218-2715
Practice Address - Street 1:105 TAMIE CT
Practice Address - Street 2:
Practice Address - City:KATHLEEN
Practice Address - State:GA
Practice Address - Zip Code:31047-2222
Practice Address - Country:US
Practice Address - Phone:478-397-7886
Practice Address - Fax:478-218-2715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP001471261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000595966Medicaid