Provider Demographics
NPI:1669540480
Name:SPEECH BEGINNINGS, INC.
Entity type:Organization
Organization Name:SPEECH BEGINNINGS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:SUSANNE
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:478-213-4604
Mailing Address - Street 1:PO BOX 26477
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31221-6477
Mailing Address - Country:US
Mailing Address - Phone:478-213-4604
Mailing Address - Fax:478-238-4796
Practice Address - Street 1:5243 RIVERSIDE DR
Practice Address - Street 2:# 1114
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-8803
Practice Address - Country:US
Practice Address - Phone:478-213-4604
Practice Address - Fax:478-238-4796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005082235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000913844CMedicaid