NPIMap

Organization Active NPI

Rogers Bridge Pediatric Therapy, LLC

  • Hearing and Speech Clinic/Center
  • Duluth, GA
National Provider Identifier
1053839456
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hearing and Speech Clinic/CenterTaxonomy code 261QH0700X
License
SLP007707 Issued in GA
Legal business name
ROGERS BRIDGE PEDIATRIC THERAPY, LLC
Practice address
2845 Summercrest LN
Duluth, GA 30096
Phone
(478) 454-8889
Fax
(678) 280-6766
NPI assigned
Sep 6, 2017
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Jessie Nelson Willis, CCC-SLPNPI 1265787485
Title
Owner
Phone
(478) 454-8889

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hearing and Speech Clinic/Center 261QH0700X SLP007707 GA Primary

Addresses

Primary practice location

2845 Summercrest LN
Duluth, GA 30096

Mailing address

2845 Summercrest LN
Duluth, GA 30096-2776
Phone (478) 454-8889

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1504656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1053839456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2845 SUMMERCREST LN",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300962776",
            "telephone_number": "478-454-8889",
            "fax_number": "678-280-6766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2845 SUMMERCREST LN",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "30096",
            "telephone_number": "478-454-8889",
            "fax_number": "678-280-6766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROGERS BRIDGE PEDIATRIC THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-06",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "WILLIS",
        "authorized_official_first_name": "JESSIE",
        "authorized_official_middle_name": "NELSON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "478-454-8889",
        "authorized_official_credential": "CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "261QH0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Hearing and Speech",
            "state": "GA",
            "license": "SLP007707",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.