NPIMap

Organization Active NPI

Coastal Speech Therapy

  • Speech-Language Pathologist
  • Woodbine, GA
National Provider Identifier
1417099755
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
CLP005987 Issued in GA
Legal business name
COASTAL SPEECH THERAPY
Practice address
24 Serenity Farms Rd
Coastal Speech Therapy
Woodbine, GA 31569
Phone
(912) 230-0024
Fax
(912) 576-5182
NPI assigned
Feb 13, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Jeanette Williamson
Title
Office Billing Manager
Phone
(912) 227-2524

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X CLP005987 GA Primary

Addresses

Primary practice location

24 Serenity Farms Rd
Coastal Speech Therapy
Woodbine, GA 31569

Mailing address

12567 Ga Hwy 110
Woodbine, GA 31569
Phone (912) 227-2524

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1417099755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12567 GA HWY 110",
            "city": "WOODBINE",
            "state": "GA",
            "postal_code": "31569",
            "telephone_number": "912-227-2524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 SERENITY FARMS RD",
            "address_2": "COASTAL SPEECH THERAPY",
            "city": "WOODBINE",
            "state": "GA",
            "postal_code": "31569",
            "telephone_number": "912-230-0024",
            "fax_number": "912-576-5182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL SPEECH THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WILLIAMSON",
        "authorized_official_first_name": "JEANETTE",
        "authorized_official_title_or_position": "OFFICE BILLING MANAGER",
        "authorized_official_telephone_number": "912-227-2524",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "CLP005987",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbine, GA

Sources for this page

  • 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.