Provider Demographics
NPI: | 1770023350 |
---|---|
Name: | WALL THERAPY & CONSULTING, LLC |
Entity Type: | Organization |
Organization Name: | WALL THERAPY & CONSULTING, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | SPEECH THERAPIST |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MELISSA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | WALL |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | SLP |
Authorized Official - Phone: | 229-326-5489 |
Mailing Address - Street 1: | 1501 5TH AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | ALBANY |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 31707-3638 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1501 5TH AVENUE |
Practice Address - Street 2: | |
Practice Address - City: | ALBANY |
Practice Address - State: | GA |
Practice Address - Zip Code: | 31707-3638 |
Practice Address - Country: | US |
Practice Address - Phone: | 229-326-5489 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2017-03-02 |
Last Update Date: | 2017-03-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
GA | SLP007890 | 235Z00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Single Specialty |