# SPEECH SPA, LLC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306241450
- **Authorized official:** MRS. AMY JO COLEMANPERRYMAN SLP (SPEECH LANGUAGE PATHOLOGIST)
- **Authorized official phone:** (678) 825-5750

## Contact information

- **Practice address:** 2260 NORTHLAKE PKWY, SUITE 210, TUCKER, GA 30084-4036
- **Practice address phone:** (678) 825-5750
- **Mailing address:** 5826 RUE VILLA LN, TUCKER, GA 30084-1966
- **Mailing address phone:** (678) 825-5750

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 252Y00000X | Early Intervention Provider Agency | SLP008019 | GA | Yes |

## Other

- **Enumeration date:** 10/31/2014
- **Last updated:** 10/31/2014