Provider Demographics
NPI:1316175375
Name:LINGUISTIC IMPRESSIONS THERAPEUTIC SERVICES, LLC
Entity type:Organization
Organization Name:LINGUISTIC IMPRESSIONS THERAPEUTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-915-2736
Mailing Address - Street 1:2451 CUMBERLAND PKWY SE
Mailing Address - Street 2:SUITE 3693
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-6136
Mailing Address - Country:US
Mailing Address - Phone:404-915-2736
Mailing Address - Fax:404-795-0840
Practice Address - Street 1:2451 CUMBERLAND PKWY SE
Practice Address - Street 2:SUITE 3693
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-6136
Practice Address - Country:US
Practice Address - Phone:404-915-2736
Practice Address - Fax:404-795-0840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-29
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006095235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA124104840IMedicaid
GA124104840GMedicaid