Organization
KIDS TALK THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDILBERTO MONTENEGRO (DIRECTOR)
(678) 898-2055
Entity
Organization
Contact information
Practice address
1113 TOWN SQUARE CT, LAWRENCEVILLE, GA 30046-8379
(404) 573-3381
Mailing address
1113 TOWN SQUARE CT, LAWRENCEVILLE, GA 30046-8379
(404) 573-3381
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
12/06/2019
Last updated
12/06/2019
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