Innovative Therapy Matters LLC

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP007195 Issued in GA

Legal business name

INNOVATIVE THERAPY MATTERS LLC

Practice address

157 Coral Dr
Brunswick, GA 31523-8951

Phone

(912) 571-6022

NPI assigned

Apr 28, 2016

Organization subpart

No

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

Authorized official

Name

Demetria L Jackson, CCC-SLPNPI 1790005791

Title

Owner

Phone

(912) 571-6022

Specialties & licenses 1

Addresses

Practitioners 1

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.

• Demetria Jackson, CCC-SLP

  • Speech-Language Pathologist
  • Brunswick, GA
  • NPI 1790005791
  NPD Authorized official

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

{
    "created_epoch": "1461801600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645660800000",
    "number": "1235584020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2246",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315212246",
            "telephone_number": "912-571-6022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "157 CORAL DR",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315238951",
            "telephone_number": "912-571-6022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE THERAPY MATTERS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-28",
        "last_updated": "2022-02-24",
        "certification_date": "2022-02-24",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "DEMETRIA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "912-571-6022",
        "authorized_official_credential": "CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP007195",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Brunswick, GA
• Providers in Brunswick, 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 Feb 24, 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.