Provider Demographics
NPI:1720823131
Name:LASTING LANGUAGE THERAPY SERVICES
Entity type:Organization
Organization Name:LASTING LANGUAGE THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:DANNER
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MED, CCC-SLP
Authorized Official - Phone:678-936-9896
Mailing Address - Street 1:411 CREEK RUN DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-1951
Mailing Address - Country:US
Mailing Address - Phone:678-936-9896
Mailing Address - Fax:678-302-7268
Practice Address - Street 1:411 CREEK RUN DR
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-1951
Practice Address - Country:US
Practice Address - Phone:678-936-9896
Practice Address - Fax:678-302-7268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty