Provider Demographics
NPI:1124342019
Name:PROFESSIONAL SPEECH & LANGUAGE THERAPY, INC
Entity type:Organization
Organization Name:PROFESSIONAL SPEECH & LANGUAGE THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:JAVONYA
Authorized Official - Middle Name:DONELL
Authorized Official - Last Name:CLEMONS
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:678-608-9601
Mailing Address - Street 1:210 WALKER ST SW UNIT 5
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30313-1213
Mailing Address - Country:US
Mailing Address - Phone:678-608-9601
Mailing Address - Fax:404-748-4482
Practice Address - Street 1:210 WALKER ST SW UNIT 5
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30313-1213
Practice Address - Country:US
Practice Address - Phone:678-608-9601
Practice Address - Fax:404-748-4482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-21
Last Update Date:2010-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech