Provider Demographics
NPI:1396438073
Name:TRIPLE C SPEECH LANGUAGE PATHOLOGY LLC
Entity type:Organization
Organization Name:TRIPLE C SPEECH LANGUAGE PATHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:BEARD-BEAL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:912-712-1480
Mailing Address - Street 1:1445 WOODMONT LN NW # 919
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2866
Mailing Address - Country:US
Mailing Address - Phone:912-712-1480
Mailing Address - Fax:
Practice Address - Street 1:258 VIRGINIA LANE NE
Practice Address - Street 2:
Practice Address - City:LUDOWICI
Practice Address - State:GA
Practice Address - Zip Code:31316
Practice Address - Country:US
Practice Address - Phone:912-712-1480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-30
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty