Provider Demographics
NPI:1801293956
Name:PROGRESSIVE SPEECH THERAPY SERVICES, L.L.C.
Entity type:Organization
Organization Name:PROGRESSIVE SPEECH THERAPY SERVICES, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLAISE
Authorized Official - Middle Name:ARLAINA
Authorized Official - Last Name:GADSDEN
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:843-870-2339
Mailing Address - Street 1:375 ROCKBRIDGE RD NW
Mailing Address - Street 2:STE 172-247
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-8225
Mailing Address - Country:US
Mailing Address - Phone:843-870-2339
Mailing Address - Fax:912-550-4355
Practice Address - Street 1:375 ROCKBRIDGE RD NW
Practice Address - Street 2:STE 172-247
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-8225
Practice Address - Country:US
Practice Address - Phone:843-870-2339
Practice Address - Fax:912-550-4355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-04
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2355S0801X
SCSLP5559235Z00000X
GASLP008564235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003150912AMedicaid