NPIMap

Organization Active NPI

Inclusive Rehabilitation LLC

  • Speech-Language Pathologist
  • Canton, GA
National Provider Identifier
1417525916
Registry record updated May 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Legal business name
INCLUSIVE REHABILITATION LLC
Practice address
133 Gold Mill PL
Canton, GA 30114-4025
Phone
(703) 400-5518
NPI assigned
Jun 12, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2026

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

Authorized official

Name
Wendy Blake, M.ED.,CCC-SLPNPI 1609010529
Title
Speech-Language Pathologist
Phone
(470) 504-4905

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language PathologistGroup: 193400000X SINGLE SPECIALTY GROUP 235Z00000X Primary

Addresses

Primary practice location

133 Gold Mill PL
Canton, GA 30114-4025

Mailing address

133 Gold Mill PL
Canton, GA 30114-4025
Phone (470) 504-4905

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210821000144 GA Part B Supplier - Clinic/Group Practice 3476958976 Receives reassigned benefits from 13 practitioners
Practice locations: Canton, GA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Inclusive Rehabilitation2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1623456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780012800000",
    "number": "1417525916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "133 GOLD MILL PL",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301144025",
            "telephone_number": "470-504-4905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 GOLD MILL PL",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301144025",
            "telephone_number": "703-400-5518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INCLUSIVE REHABILITATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-12",
        "last_updated": "2026-05-29",
        "certification_date": "2026-05-29",
        "status": "A",
        "authorized_official_last_name": "BLAKE",
        "authorized_official_first_name": "WENDY",
        "authorized_official_title_or_position": "SPEECH-LANGUAGE PATHOLOGIST",
        "authorized_official_telephone_number": "470-504-4905",
        "authorized_official_credential": "M.ED.,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": []
}

Other providers in Canton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.