Speech Spa, LLC.

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

License

SLP008019 Issued in GA

Legal business name

SPEECH SPA, LLC.

Practice address

2260 Northlake Pkwy
Suite 210
Tucker, GA 30084-4036

Phone

(678) 825-5750

NPI assigned

Oct 31, 2014

Organization subpart

No

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

Authorized official

Name

Mrs. Amy Jo Colemanperryman, SLP

Title

Speech Language Pathologist

Phone

(678) 825-5750

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1414713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414713600000",
    "number": "1306241450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5826 RUE VILLA LN",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300841966",
            "telephone_number": "678-825-5750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2260 NORTHLAKE PKWY",
            "address_2": "SUITE 210",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300844036",
            "telephone_number": "678-825-5750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPEECH SPA, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-31",
        "last_updated": "2014-10-31",
        "status": "A",
        "authorized_official_last_name": "COLEMANPERRYMAN",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "JO",
        "authorized_official_title_or_position": "SPEECH LANGUAGE PATHOLOGIST",
        "authorized_official_telephone_number": "678-825-5750",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "SLP"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "GA",
            "license": "SLP008019",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003131271C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Early Intervention Provider Agency in Tucker, GA
• Providers in Tucker, GA by specialty
• Early Intervention Provider Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2014; 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.