Provider Demographics
NPI:1144519778
Name:SPEECH ON THE GO, INC.
Entity type:Organization
Organization Name:SPEECH ON THE GO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RUSSEL
Authorized Official - Last Name:HELTON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:678-316-4338
Mailing Address - Street 1:4864 RED OAK DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30506-5375
Mailing Address - Country:US
Mailing Address - Phone:678-316-4338
Mailing Address - Fax:186-635-3578
Practice Address - Street 1:4864 RED OAK DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30506-5375
Practice Address - Country:US
Practice Address - Phone:678-316-4338
Practice Address - Fax:186-635-3578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP000669235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000559589DMedicaid
GA307631OtherWELLCARE
GA10036211OtherAMERIGROUP