Provider Demographics
NPI:1245650027
Name:TWIST & SHOUT: CHILDREN'S THERAPY SERVICES, LLC
Entity type:Organization
Organization Name:TWIST & SHOUT: CHILDREN'S THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:GUERIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:404-543-7296
Mailing Address - Street 1:4123 N GLOUCESTER PL
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1212
Mailing Address - Country:US
Mailing Address - Phone:404-543-7296
Mailing Address - Fax:888-978-5662
Practice Address - Street 1:1816 BRIARWOOD INDUSTRIAL CT NE STE A
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30329-1642
Practice Address - Country:US
Practice Address - Phone:404-543-7296
Practice Address - Fax:888-978-5662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-21
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007925235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty