NPI 1134460363

Innovative Therapy Services

Organisation Early Intervention Provider Agency Stone Mountain, GA

Practice location

Address: 632 Tahoe Cir, Stone Mountain, GA 30083-4450
Phone: (301) 646-0304

Authorised official

Name: Tasha Michelle Winns
Title: Speech Pathologist
Phone: (301) 646-0304

Registered specialties

Early Intervention Provider Agency Primary

Agencies Taxonomy 252Y00000X Licence SLP007594 (GA)

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Registry record

NPI: 1134460363
Entity type: Organization
NPI issued: 13 Mar 2013
Record last updated: 13 Mar 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.