Provider Demographics
NPI:1720421399
Name:SPEECH LANGUAGE AND BEYOND, LLC
Entity Type:Organization
Organization Name:SPEECH LANGUAGE AND BEYOND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:ASHELY
Authorized Official - Middle Name:
Authorized Official - Last Name:SELLERS
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:229-638-0627
Mailing Address - Street 1:514 DIVINE DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31721-9547
Mailing Address - Country:US
Mailing Address - Phone:229-638-0627
Mailing Address - Fax:229-496-5277
Practice Address - Street 1:514 DIVINE DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31721-9547
Practice Address - Country:US
Practice Address - Phone:229-638-0627
Practice Address - Fax:229-496-5277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007125251C00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA844552268BMedicaid