Provider Demographics
NPI:1871986653
Name:ISPEAK THERAPY SERVICES LLC
Entity type:Organization
Organization Name:ISPEAK THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ALFREDA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:470-210-4301
Mailing Address - Street 1:1388 VILLAGE CREEK CIR SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-3281
Mailing Address - Country:US
Mailing Address - Phone:470-210-4301
Mailing Address - Fax:888-975-4313
Practice Address - Street 1:1388 VILLAGE CREEK CIR SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-3281
Practice Address - Country:US
Practice Address - Phone:470-210-4301
Practice Address - Fax:888-975-4313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006824235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003157207AMedicaid