Provider Demographics
NPI:1912481367
Name:COASTAL SPEECH AND FEEDING LLC
Entity Type:Organization
Organization Name:COASTAL SPEECH AND FEEDING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:STUCKEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:912-306-9839
Mailing Address - Street 1:104 CARLTON RD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-4304
Mailing Address - Country:US
Mailing Address - Phone:912-306-9839
Mailing Address - Fax:
Practice Address - Street 1:104 CARLTON RD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31410-4304
Practice Address - Country:US
Practice Address - Phone:912-306-9839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-21
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003201925AMedicaid