Childrens Therapy Center

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP005585 Issued in GA

Legal business name

CHILDRENS THERAPY CENTER

Practice address

1500 Oglethorpe Ave
Suite 500 D
Athens, GA 30606-2179

Phone

(706) 353-3573

Fax

(706) 353-1606

NPI assigned

Dec 19, 2006

Last updated

Aug 22, 2020By 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. Jennifer Raulerson, CCC SLP

Title

Seech Pathologist

Phone

(706) 353-3575

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1205990009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 OGLETHORPE AVE",
            "address_2": "SUITE 500 D",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306062179",
            "telephone_number": "706-353-3573",
            "fax_number": "706-353-1606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 OGLETHORPE AVE",
            "address_2": "SUITE 500 D",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306062179",
            "telephone_number": "706-353-3573",
            "fax_number": "706-353-1606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDRENS THERAPY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RAULERSON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "SEECH PATHOLOGIST",
        "authorized_official_telephone_number": "706-353-3575",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CCC SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP005585",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "833369342A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Athens, GA
• Providers in Athens, 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 Aug 22, 2020; 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.