Provider Demographics
NPI:1760139562
Name:DEEPER ROOTS SPEECH THERAPY, LLC
Entity Type:Organization
Organization Name:DEEPER ROOTS SPEECH THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:LEDFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:423-915-6573
Mailing Address - Street 1:813 TRACE LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4003
Mailing Address - Country:US
Mailing Address - Phone:601-654-4912
Mailing Address - Fax:
Practice Address - Street 1:813 TRACE LN
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4003
Practice Address - Country:US
Practice Address - Phone:601-654-4912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty