Organization Name: | INNOVATIVE THEARPY MATTERS LLC |
NPI Number: | 1235584020 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DEMETRIA L JACKSON (OWNER) |
Mailing Address: | 4144 Cobblestone Park Dr Milledgeville |
State: | GA US |
Postal Code: | 310616658 |
Phone Number: | 9125716022 |
Fax Number: | |
NPI Enumeration Date: | 04/28/2016 |
NPI Last Update Date: | 04/28/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SLP007195 |
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 |