Impactful Therapy Services LLC

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Legal business name

IMPACTFUL THERAPY SERVICES LLC

Practice address

308 Tollerton Ave
Saint Johns, FL 32259-6305

Phone

(404) 452-1640

NPI assigned

Apr 6, 2016

Organization subpart

No

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

Authorized official

Name

Elizabeth Adeyemo, CCC-SLP

Title

Speech-Language Pathologist

Phone

(404) 452-1640

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1459900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459900800000",
    "number": "1306200373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 TOLLERTON AVE",
            "city": "SAINT JOHNS",
            "state": "FL",
            "postal_code": "322596305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 TOLLERTON AVE",
            "city": "SAINT JOHNS",
            "state": "FL",
            "postal_code": "322596305",
            "telephone_number": "404-452-1640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACTFUL THERAPY SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-06",
        "last_updated": "2016-04-06",
        "status": "A",
        "authorized_official_last_name": "ADEYEMO",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "SPEECH-LANGUAGE PATHOLOGIST",
        "authorized_official_telephone_number": "404-452-1640",
        "authorized_official_credential": "CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Saint Johns, FL
• Providers in Saint Johns, FL by specialty
• Speech-Language Pathologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2016; 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.