| Organization Name: | DIVINE INTERVENTION SPEECH-LANGUAGE THERAPY SERVICES, LLC |
| NPI Number: | 1083013023 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KEISHA BANKS (OWNER) |
| Mailing Address: | 108 S Highway 135 Suite A Lakeland |
| State: | GA US |
| Postal Code: | 316356356 |
| Phone Number: | 2295601135 |
| Fax Number: | 2294552099 |
| NPI Enumeration Date: | 08/15/2014 |
| NPI Last Update Date: | 08/15/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| 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 |