Carly Reineri Thellman, M.ED., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP011717 Issued in GA

Practice address

11285 Elkins Rd Ste G2
Roswell, GA 30076-1259

Phone

(678) 824-2145

NPI assigned

Jan 16, 2023

Last updated

Jan 16, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Milton Speech Pathology, LLC

  dba Amy Squires, SLP

  • Speech-Language Pathologist
  • Roswell, GA
  • NPI 1679020499
  NPD

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

{
    "created_epoch": "1673827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673827200000",
    "number": "1538874441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11285 ELKINS RD STE G2",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300761259",
            "telephone_number": "678-824-2145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11285 ELKINS RD STE G2",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300761259",
            "telephone_number": "678-824-2145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THELLMAN",
        "first_name": "CARLY",
        "middle_name": "REINERI",
        "credential": "M.ED., CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-16",
        "last_updated": "2023-01-16",
        "certification_date": "2023-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP011717",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "ClinicSource",
            "affiliation": "N",
            "address_1": "11285 Elkins Rd Ste G2",
            "city": "Roswell",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300761259",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Speech-Language Pathologist in Roswell, GA
• Providers in Roswell, GA by specialty
• Speech-Language Pathologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2023; 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.