Provider Demographics
NPI:1063792729
Name:TIME FOR SPEECH, INC
Entity type:Organization
Organization Name:TIME FOR SPEECH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:LAUDERDALE
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:706-410-7610
Mailing Address - Street 1:75 OLD EDWARDS RD
Mailing Address - Street 2:
Mailing Address - City:ARNOLDSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30619-1903
Mailing Address - Country:US
Mailing Address - Phone:706-410-7610
Mailing Address - Fax:866-753-4652
Practice Address - Street 1:75 OLD EDWARDS RD
Practice Address - Street 2:
Practice Address - City:ARNOLDSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30619-1903
Practice Address - Country:US
Practice Address - Phone:706-410-7610
Practice Address - Fax:866-753-4652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-25
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP000407235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000726822BMedicaid