Provider Demographics
NPI:1992202162
Name:FITLY SPOKEN, LLC
Entity Type:Organization
Organization Name:FITLY SPOKEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPSON-WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:678-713-4609
Mailing Address - Street 1:4262 CLAUSELL CT STE A
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-1916
Mailing Address - Country:US
Mailing Address - Phone:678-713-4609
Mailing Address - Fax:844-308-4956
Practice Address - Street 1:4262 CLAUSELL CT STE A
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035
Practice Address - Country:US
Practice Address - Phone:678-713-4609
Practice Address - Fax:844-308-4956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-12
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty