Provider Demographics
NPI:1841759313
Name:OUTSPOKEN THERAPY SERVICES , INC
Entity Type:Organization
Organization Name:OUTSPOKEN THERAPY SERVICES , INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:SEAY
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, CCC-SLP
Authorized Official - Phone:404-281-8270
Mailing Address - Street 1:6788 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-4700
Mailing Address - Country:US
Mailing Address - Phone:770-907-8061
Mailing Address - Fax:
Practice Address - Street 1:6788 CHURCH ST
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-4700
Practice Address - Country:US
Practice Address - Phone:770-907-8061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000950045CMedicaid