Provider Demographics
NPI:1548490113
Name:STEP N STONES SPEECH LANGUAGE THERAPY SERVICE
Entity type:Organization
Organization Name:STEP N STONES SPEECH LANGUAGE THERAPY SERVICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINIKA
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:DISMUKE
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:229-227-1433
Mailing Address - Street 1:1102 SMITH AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-5739
Mailing Address - Country:US
Mailing Address - Phone:229-227-1433
Mailing Address - Fax:229-226-6353
Practice Address - Street 1:1102 SMITH AVE
Practice Address - Street 2:SUITE C
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-5739
Practice Address - Country:US
Practice Address - Phone:229-227-1433
Practice Address - Fax:229-226-6353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-17
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty