Provider Demographics
NPI:1740410893
Name:CORNERSTONE SPEECH LANGUAGE AND LEARNING CENTER; INC.
Entity Type:Organization
Organization Name:CORNERSTONE SPEECH LANGUAGE AND LEARNING CENTER; INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MED, CCC-SLP
Authorized Official - Phone:706-625-3264
Mailing Address - Street 1:113 DUBLIN DR SE
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-4462
Mailing Address - Country:US
Mailing Address - Phone:706-625-3264
Mailing Address - Fax:706-625-0175
Practice Address - Street 1:113 DUBLIN DR SE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-4462
Practice Address - Country:US
Practice Address - Phone:706-625-3264
Practice Address - Fax:706-625-0175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP000996235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000795748BMedicaid