Provider Demographics
NPI:1992145627
Name:FUTURE GENERATION SPEECH AND LEARNING SERVICES
Entity type:Organization
Organization Name:FUTURE GENERATION SPEECH AND LEARNING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:YEVONNE
Authorized Official - Last Name:DORSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MED, CCC-SLP
Authorized Official - Phone:404-510-8892
Mailing Address - Street 1:334 GRAVES RD
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-6172
Mailing Address - Country:US
Mailing Address - Phone:404-510-8892
Mailing Address - Fax:
Practice Address - Street 1:334 GRAVES RD
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-6172
Practice Address - Country:US
Practice Address - Phone:404-510-8892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007224235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty