Provider Demographics
NPI:1740639236
Name:CHATTERBOX SPEECH AND LANGUAGE CLINIC
Entity type:Organization
Organization Name:CHATTERBOX SPEECH AND LANGUAGE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:DUCEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:404-518-5000
Mailing Address - Street 1:4651 ROSWELL RD
Mailing Address - Street 2:SUITE E-404
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-3048
Mailing Address - Country:US
Mailing Address - Phone:404-518-5000
Mailing Address - Fax:855-417-9070
Practice Address - Street 1:4651 ROSWELL RD
Practice Address - Street 2:SUITE E-404
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3048
Practice Address - Country:US
Practice Address - Phone:404-518-5000
Practice Address - Fax:855-417-9070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005787235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA502161594CMedicaid