Provider Demographics
NPI:1790091437
Name:SPEECH THEREPEZE, INC.
Entity Type:Organization
Organization Name:SPEECH THEREPEZE, INC.
Other - Org Name:PROGRESSIVE THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPEECH/LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:VONTRECYE
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:404-551-0222
Mailing Address - Street 1:4979 TADMORE LN
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-2237
Mailing Address - Country:US
Mailing Address - Phone:404-551-0222
Mailing Address - Fax:770-696-3022
Practice Address - Street 1:2855 CANDLER RD
Practice Address - Street 2:SUITE 14
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-1415
Practice Address - Country:US
Practice Address - Phone:404-328-0055
Practice Address - Fax:770-696-3022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006022235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA440163644AMedicaid