NPIMap

Organization Active NPI

Dynamic Therapy Associates, Inc

  • Speech-Language Pathologist
  • Kennesaw, GA
National Provider Identifier
1750359808
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
003536 Issued in GA
Legal business name
DYNAMIC THERAPY ASSOCIATES, INC
Practice address
3166 Cherokee St NW
Suite 101
Kennesaw, GA 30144-2883
Phone
(678) 521-4692
NPI assigned
Mar 14, 2006
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
Mrs. Vicki K Clarke, M.S. CCC-SLPNPI 1669541223
Title
President
Phone
(678) 521-4692

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: 193200000X MULTI-SPECIALTY GROUP 235Z00000X 003536 GA Primary

Addresses

Primary practice location

3166 Cherokee St NW
Suite 101
Kennesaw, GA 30144-2883

Mailing address

2841 Patches CT NW
Kennesaw, GA 30152-5856
Phone (678) 521-4692

Other identifiers 2

IdentifierTypeStateIssuer
PR01733450001OtherTNCIGNA VENDOR NO.
52754489OtherGABC/BS PROVIDER NO.

National Provider Directory

National Provider Directory

Locations

3105 Creekside Village Dr NW
Ste 603
Kennesaw, GA 30144
Phone (770) 974-2424

3166 Cherokee St NW
Ste 101
Kennesaw, GA 30144
Phone (678) 290-6524

Practitioners & affiliated clinicians

Practitioners 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1750359808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2841 PATCHES CT NW",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301525856",
            "telephone_number": "678-521-4692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3166 CHEROKEE ST NW",
            "address_2": "SUITE 101",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301442883",
            "telephone_number": "678-521-4692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC THERAPY ASSOCIATES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CLARKE",
        "authorized_official_first_name": "VICKI",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "678-521-4692",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "M.S. CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "003536",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA VENDOR NO.",
            "identifier": "PR01733450001",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS PROVIDER NO.",
            "identifier": "52754489",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kennesaw, 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.