Organization
CRUCIBLE COMMUNICATION THERAPY LLC
Active
Other names
Crucible Communication Therapy LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GLENN BARNES M,ED. CCC-SLP (CEO)
(770) 570-2140
Entity
Organization
Contact information
Practice address
9765 WALNUT GROVE TRAIL, VILLA RICA, GA 30180
(770) 727-2732
Mailing address
9765 WALNUT GROVE TRAIL, VILLA RICA, GA 30180
(770) 727-2732
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SLP010654
—
GA
Enumeration date
12/16/2019
Last updated
12/16/2019
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