Provider Demographics
NPI:1851717300
Name:SPEECH THERAPLAY, LLC
Entity Type:Organization
Organization Name:SPEECH THERAPLAY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:A
Authorized Official - Middle Name:
Authorized Official - Last Name:PATIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCC-SLP
Authorized Official - Phone:866-770-7294
Mailing Address - Street 1:2821 MAIN ST W
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-3149
Mailing Address - Country:US
Mailing Address - Phone:866-770-7294
Mailing Address - Fax:866-770-7294
Practice Address - Street 1:2821 MAIN ST W
Practice Address - Street 2:SUITE 6
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3149
Practice Address - Country:US
Practice Address - Phone:866-770-7294
Practice Address - Fax:866-770-7294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-07
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006184235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty