Provider Demographics
NPI:1447691993
Name:NORTH PAULDING SPEECH LANGUAGE THERAPY
Entity type:Organization
Organization Name:NORTH PAULDING SPEECH LANGUAGE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:KNOTT-RIGGALL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:561-801-3148
Mailing Address - Street 1:283 RED HAWK WAY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-1149
Mailing Address - Country:US
Mailing Address - Phone:561-801-3148
Mailing Address - Fax:678-401-6655
Practice Address - Street 1:283 RED HAWK WAY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-1149
Practice Address - Country:US
Practice Address - Phone:561-801-3148
Practice Address - Fax:678-401-6655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007396235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003126293AMedicaid