Letha Campbell, M.ED., CCC-SLP
Individual provider Active NPI Speech-Language Pathologist · Villa Rica, GA
NPI 1487710588 · NPPES record last updated Feb 20, 2015
Key facts
- NPI
- 1487710588
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- SLP006046 (GA)
- Practice address
- 5016 Grist Mill Dr
Villa Rica, GA 30180-5401 - Phone
- (770) 783-9498
- Fax
- (877) 977-9552
- NPI assigned
- Dec 31, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Education
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SLP006046 | GA | Yes |
Addresses
Primary practice location
5016 Grist Mill Dr
Villa Rica, GA 30180-5401
Mailing address
5016 Grist Mill Dr
Villa Rica, GA 30180-5401
Phone (770) 783-9498
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 571152749 | Other | GA | BCBS |
| 571152749 | Other | GA | TRICARE |
| 786634130A | Other | GA | PEACHSTATE |
| 571152749 | Other | GA | COVENTRY |
| 571152749 | Other | GA | UNITED HEALTHCARE |
| 100842 | Other | GA | TRADING PARTNER |
| 786634130A | Medicaid | GA | |
| 867779344A | Other | GA | PAYEE ID |
| 786634130F | Medicaid | GA |
Other names
- Letha Koenighaus
Other providers in Villa Rica, GA
- Hector Alejandro Caceres Serrano
- Shazaria Calhoun
- Calming Spirits Caregivers LLC
- Bruce Anthony Camp
- Nathaniel Camp
- Sheri Campbell
- Carrie Cares Transportation
- William Mason Carroll
- William Thomas Carroll III
- Carrollton Orthopaedic Clinic PC
All providers in Villa Rica, GA · Speech-Language Pathologist in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 20, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.