Provider Demographics
NPI:1396120150
Name:SPEECH CLINIC OF THE COASTAL EMPIRE LLC
Entity type:Organization
Organization Name:SPEECH CLINIC OF THE COASTAL EMPIRE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRIN
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:912-614-7847
Mailing Address - Street 1:130 STEPHENSON AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5899
Mailing Address - Country:US
Mailing Address - Phone:912-712-3999
Mailing Address - Fax:912-438-6907
Practice Address - Street 1:130 STEPHENSON AVE STE 102
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5899
Practice Address - Country:US
Practice Address - Phone:912-712-3999
Practice Address - Fax:912-438-6907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-22
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty