Provider Demographics
NPI:1184370041
Name:SIMPLY STATED SLP SERVICES, LLC
Entity type:Organization
Organization Name:SIMPLY STATED SLP SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:TAMEKA
Authorized Official - Middle Name:BLANETTE
Authorized Official - Last Name:BACON
Authorized Official - Suffix:
Authorized Official - Credentials:MED, CCC
Authorized Official - Phone:404-808-2323
Mailing Address - Street 1:7327 VIGO DR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-5966
Mailing Address - Country:US
Mailing Address - Phone:404-808-2323
Mailing Address - Fax:
Practice Address - Street 1:7327 VIGO DR
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-5966
Practice Address - Country:US
Practice Address - Phone:404-808-2323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech