Provider Demographics
NPI:1588378228
Name:FUNCTIONAL COMMUNICATION FOUNDATIONS LLC
Entity type:Organization
Organization Name:FUNCTIONAL COMMUNICATION FOUNDATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:MERIDITH
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:561-670-3545
Mailing Address - Street 1:3465 DULUTH HIGHWAY 120 APT 5417
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-3457
Mailing Address - Country:US
Mailing Address - Phone:561-670-3545
Mailing Address - Fax:
Practice Address - Street 1:3465 DULUTH HIGHWAY 120 APT 5417
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-3457
Practice Address - Country:US
Practice Address - Phone:561-670-3545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty