Organization
SPEECH SPA, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AMY JO COLEMANPERRYMAN SLP (SPEECH LANGUAGE PATHOLOGIST)
(678) 825-5750
Entity
Organization
Contact information
Practice address
2260 NORTHLAKE PKWY, SUITE 210, TUCKER, GA 30084-4036
(678) 825-5750
Mailing address
5826 RUE VILLA LN, TUCKER, GA 30084-1966
(678) 825-5750
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
SLP008019
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003131271C
—
GA
Enumeration date
10/31/2014
Last updated
10/31/2014
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