Provider Demographics
NPI:1821469099
Name:TERRI H. COHEN DBA SPEECH AND LANGUAGE SERVICES
Entity Type:Organization
Organization Name:TERRI H. COHEN DBA SPEECH AND LANGUAGE SERVICES
Other - Org Name:MIRACLE KIDS, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:HASKINS
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:770-642-0670
Mailing Address - Street 1:11050 CRABAPPLE RD
Mailing Address - Street 2:BLDG D SUITE 115-A
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2489
Mailing Address - Country:US
Mailing Address - Phone:770-642-0670
Mailing Address - Fax:
Practice Address - Street 1:1442 DRESDEN DR NE
Practice Address - Street 2:UNIT 258
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-3590
Practice Address - Country:US
Practice Address - Phone:770-642-0670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-14
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP001587261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech