JLD Speech Therapy, LLC

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

005166 Issued in GA

Legal business name

JLD SPEECH THERAPY, LLC

Practice address

618 Bowens Mill Rd SW
Douglas, GA 31533-3926

Phone

(912) 539-1612

Fax

(912) 764-6494

NPI assigned

Jan 17, 2010

Last updated

Jan 17, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Jayla S Bullock, M.ED., CCC/SLP

Title

Owner/ Speech Language Pathologist

Phone

(912) 539-1612

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1263686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263686400000",
    "number": "1063743953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3306",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315343306",
            "telephone_number": "912-539-1612",
            "fax_number": "912-764-6494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "618 BOWENS MILL RD SW",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315333926",
            "telephone_number": "912-539-1612",
            "fax_number": "912-764-6494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JLD SPEECH THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-17",
        "last_updated": "2010-01-17",
        "status": "A",
        "authorized_official_last_name": "BULLOCK",
        "authorized_official_first_name": "JAYLA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER/ SPEECH LANGUAGE PATHOLOGIST",
        "authorized_official_telephone_number": "912-539-1612",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "M.ED., CCC/SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "005166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Douglas, GA
• Providers in Douglas, GA by specialty
• Speech-Language Pathologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2010; 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.