Provider Demographics
NPI:1720600083
Name:SPEECH EVOLVE THERAPY SERVICES, LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:SPEECH EVOLVE THERAPY SERVICES, LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ SPEECH THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:CIERRA
Authorized Official - Last Name:CO
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:404-484-8685
Mailing Address - Street 1:3980 AMBROSE RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-6257
Mailing Address - Country:US
Mailing Address - Phone:404-484-8685
Mailing Address - Fax:
Practice Address - Street 1:3980 AMBROSE RIDGE CT
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-6257
Practice Address - Country:US
Practice Address - Phone:404-484-8685
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-10
Last Update Date:2020-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty