Organization Name: | JLD SPEECH THERAPY, LLC |
NPI Number: | 1063743953 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JAYLA S BULLOCK (OWNER/ SPEECH LANGUAGE PATHOLOGIST) |
Mailing Address: | 618 Bowens Mill Rd Sw Douglas |
State: | GA US |
Postal Code: | 315333926 |
Phone Number: | 9125391612 |
Fax Number: | 9127646494 |
NPI Enumeration Date: | 01/17/2010 |
NPI Last Update Date: | 01/17/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 005166 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |