Organization
MILTON SPEECH PATHOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY SQUIRES (OWNER)
(404) 719-3991
Entity
Organization
Contact information
Practice address
1004 BOMBAY LN, ROSWELL, GA 30076-5820
(404) 719-3991
Mailing address
1004 BOMBAY LN, ROSWELL, GA 30076-5820
(404) 719-3991
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP008235
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003153554C
—
GA
Enumeration date
12/07/2016
Last updated
12/09/2016
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