Glow Forward Therapy, LLC

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Legal business name

GLOW FORWARD THERAPY, LLC

Practice address

1994 Township Dr
Winder, GA 30680-5633

Phone

(252) 258-6200

NPI assigned

Jul 24, 2025

Organization subpart

No

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

Authorized official

Name

Traci Reid LeakNPI 1013357649

Title

Ms, CCC-SLP

Phone

(252) 258-6200

Specialties & licenses 1

Addresses

Practitioners 1

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

• Traci Reid Leak, MS, CCC,SLP

  • Speech-Language Pathologist
  • Winder, GA
  • NPI 1013357649
  NPD Authorized official

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

{
    "created_epoch": "1753315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753315200000",
    "number": "1861374381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1994 TOWNSHIP DR",
            "city": "WINDER",
            "state": "GA",
            "postal_code": "306805633",
            "telephone_number": "252-258-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1994 TOWNSHIP DR",
            "city": "WINDER",
            "state": "GA",
            "postal_code": "306805633",
            "telephone_number": "252-258-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLOW FORWARD THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-24",
        "last_updated": "2025-07-24",
        "certification_date": "2025-07-24",
        "status": "A",
        "authorized_official_last_name": "LEAK",
        "authorized_official_first_name": "TRACI",
        "authorized_official_middle_name": "REID",
        "authorized_official_title_or_position": "MS, CCC-SLP",
        "authorized_official_telephone_number": "252-258-6200"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pamela S Gewirtz, OD
• Taylor Burch Gibson
• Rachelle Lea Gilmore, FNP
• Kierra Glenn
• Sara Glore
• Jordan Anne Gotreaux
• Amber Nichole Gould
• Kaitlyn Shea Graham, PHARMD
• Chalon Gray, RNC-OB
• Crystal Renee Grayson, CRNA

• Speech-Language Pathologist in Winder, GA
• Providers in Winder, 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 Jul 24, 2025; 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.