Provider Demographics
NPI:1811641863
Name:SPEECH AND SWALLOW STUDIO, LLC
Entity type:Organization
Organization Name:SPEECH AND SWALLOW STUDIO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CALESA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:LEACH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:662-549-1465
Mailing Address - Street 1:3005 WOODIRON DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-3726
Mailing Address - Country:US
Mailing Address - Phone:662-549-1465
Mailing Address - Fax:
Practice Address - Street 1:3005 WOODIRON DR
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-3726
Practice Address - Country:US
Practice Address - Phone:662-549-1465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech