NPIMap

Organization Active NPI

Impact Therapy of Georgia

  • Speech-Language Pathologist
  • Warner Robins, GA
National Provider Identifier
1013360601
Registry record updated Apr 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Legal business name
IMPACT THERAPY OF GEORGIA
Practice address
524 S Houston Lake Rd Ste B300
Warner Robins, GA 31088-9042
Phone
(678) 910-3940
Fax
(404) 464-0819
NPI assigned
Jul 19, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jennifer Wenkel, SLPNPI 1801223979
Title
Owner/SLP
Phone
(678) 910-3940

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X Primary

Addresses

Primary practice location

524 S Houston Lake Rd Ste B300
Warner Robins, GA 31088-9042

Mailing address

107 Grand View Ave
Kathleen, GA 31047-2747
Phone (678) 910-3940

Other names 1

  • Impact Therapy Doing business as

National Provider Directory

National Provider Directory

Locations

1291 S Houston Lake Rd
Ste G
Warner Robins, GA 31088
Phone (478) 235-7024

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1468886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554422400000",
    "number": "1013360601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 GRAND VIEW AVE",
            "city": "KATHLEEN",
            "state": "GA",
            "postal_code": "310472747",
            "telephone_number": "678-910-3940",
            "fax_number": "404-464-0819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "524 S HOUSTON LAKE RD STE B300",
            "city": "WARNER ROBINS",
            "state": "GA",
            "postal_code": "310889042",
            "telephone_number": "678-910-3940",
            "fax_number": "404-464-0819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT THERAPY OF GEORGIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-19",
        "last_updated": "2019-04-05",
        "status": "A",
        "authorized_official_last_name": "WENKEL",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OWNER/SLP",
        "authorized_official_telephone_number": "678-910-3940",
        "authorized_official_credential": "SLP"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Impact Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Impact Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Warner Robins, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.