Provider Demographics
NPI:1679157804
Name:LEAPS AND BOUNDS SPEECH THERAPY SERVICES
Entity type:Organization
Organization Name:LEAPS AND BOUNDS SPEECH THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:ALTHEA
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:MED, CCC-SLP
Authorized Official - Phone:404-510-9605
Mailing Address - Street 1:830 GLENWOOD AVE SE STE 510-412
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-1966
Mailing Address - Country:US
Mailing Address - Phone:404-510-9605
Mailing Address - Fax:
Practice Address - Street 1:3160 OAKDALE RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30354-1036
Practice Address - Country:US
Practice Address - Phone:404-510-9605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-12
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech