Provider Demographics
NPI:1649041203
Name:INTOWN SPEECH THERAPY, LLC
Entity type:Organization
Organization Name:INTOWN SPEECH THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:FONTENOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-533-3944
Mailing Address - Street 1:4420 PEACHTREE RD NE APT 1207
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-2702
Mailing Address - Country:US
Mailing Address - Phone:251-533-3944
Mailing Address - Fax:
Practice Address - Street 1:4420 PEACHTREE RD NE APT 1207
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-2702
Practice Address - Country:US
Practice Address - Phone:251-533-3944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech