Provider Demographics
NPI:1699914424
Name:COMMUNICATION STATION, LLC
Entity type:Organization
Organization Name:COMMUNICATION STATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CCC-SLP
Authorized Official - Prefix:MS
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:BLACKBURN
Authorized Official - Last Name:CANADY
Authorized Official - Suffix:
Authorized Official - Credentials:MED,
Authorized Official - Phone:706-364-1486
Mailing Address - Street 1:601 N BELAIR SQ
Mailing Address - Street 2:SUITE 19
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-4321
Mailing Address - Country:US
Mailing Address - Phone:706-364-1486
Mailing Address - Fax:706-364-1487
Practice Address - Street 1:601 N BELAIR SQ
Practice Address - Street 2:SUITE 19
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-4321
Practice Address - Country:US
Practice Address - Phone:706-364-1486
Practice Address - Fax:706-364-1487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA238975068AMedicaid