CRUCIBLE COMMUNICATION THERAPY LLC (NPI# 1174161624) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174161624 |
| Entity Type | Organization |
| Organization Name | CRUCIBLE COMMUNICATION THERAPY LLC |
| Practice Address |
9765 Walnut Grove Trail Villa Rica GA 30180 |
| Practice Telephone | 7707272732 |
| Mailing Telephone | 7707272732 |
| Enumeration Date | 2019-12-16 |
| Last Update Date | 2019-12-16 |
| Authorized Official Name | MR. GLENN BARNES (CEO) |
| Authorized Official Telephone | 7705702140 |
| Authorized Official Credential | M,ED. CCC-SLP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 235Z00000X | Speech-Language Pathologist | Speech, Language and Hearing Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | SLP010654 | 05 |
| Other Name | Type Code |
|---|---|
| Crucible Communication Therapy LLC | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | CRUCIBLE COMMUNICATION THERAPY LLC | 9765 Walnut Grove Trl, Villa Rica, GA 30180-4190 |
| Street Address |
9765 WALNUT GROVE TRAIL |
| City | VILLA RICA |
| State | GA |
| Zip Code | 30180 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366802845 | Medic-pearl, LLC | Ambulance | 1108 Charter Oak Ct, Villa Rica, GA 30180 | 2016-02-26 |
| 1396138368 | Josette Etienne | Nurse Practitioner | 403 Permian Way Suite A, Villa Rica, GA 30180 | 2015-03-13 |
| 1447690516 | Judith L.m. Thigpen | Nurse Practitioner | 736 Highway 78 West, Minute Clinic, Villa Rica, GA 30180 | 2013-07-03 |
| 1477890168 | Wesley Douglas Mckenzie | Pharmacist | 2500 Mirror Lake Blvd, Villa Rica, GA 30180 | 2013-01-15 |
| 1497005359 | Malika Remie Rajendra | Optometrist | 600 Hwy 61, Villa Rica, GA 30180 | 2012-09-18 |
| 1972876449 | Catherine Elaine Tyson | Pharmacist | 601 Dallas Road, Villa Rica, GA 30180 | 2012-02-14 |
| 1619262433 | Villa Rica Rx LLC | Pharmacy | 222 West Wilson Street, Villa Rica, GA 30180 | 2011-06-09 |
| 1851602874 | Jules Chopin Sybert | Nurse Practitioner | 736 W. Bankhead Hwy, Villa Rica, GA 30180 | 2010-06-24 |
| 1487984019 | Lisa Wood | Occupational Therapy Assistant | 1207 Woods Walk, Villa Rica, GA 30180 | 2010-01-04 |
| 1023281011 | Physicians Family Medicine, LLC | Clinic/Center | 209 Cooley Drive, Villa Rica, GA 30180 | 2008-04-10 |
| Find all providers in zip 30180 | ||||
| Taxonomy Code | 235Z00000X |
| Grouping | Speech, Language and Hearing Service Providers |
| Classification | Speech-Language Pathologist |
| The speech-language pathologist is the professional who engages in clinical services, prevention, advocacy, education, administration, and research in the areas of communication and swallowing across the life span from infancy through geriatrics. Speech-language pathologists address typical and atypical impairments and disorders related to communication and swallowing in the areas of speech sound production, resonance, voice, fluency, language (comprehension and expression), cognition, and feeding and swallowing. |
| Notes: "Scope of Practice in Speech-Language Pathology", American Speech-Language-Hearing Association, 2013. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821582230 | Carollynn Mcmahan | Speech-Language Pathologist | 5058 Britton Dr, Villa Rica, GA 30180-8620 | 2018-06-19 |
| 1174973457 | Lynne Long | Speech-Language Pathologist | 285 Blackstock Rd, Villa Rica, GA 30180-4713 | 2016-06-16 |
| 1487710588 | Letha Campbell | Speech-Language Pathologist | 5016 Grist Mill Dr, Villa Rica, GA 30180-5401 | 2006-12-31 |
| 1841858511 | Crystal Jeffers | Speech-Language Pathologist | 113 Commons Way Ste 402, Villa Rica, GA 30180-7040 | 2019-05-29 |
| 1801368378 | Therapy Excellence | Speech-Language Pathologist | 113 Commons Way Ste 402, Villa Rica, GA 30180-7040 | 2018-12-21 |
| 1578081527 | Kathryn Swales | Speech-Language Pathologist | 2001 Church Ln, Villa Rica, GA 30180-4720 | 2017-08-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801496484 | Tracey Samet Grant | Speech-Language Pathologist | 660 Glenairy Dr, Sandy Springs, GA 30328-4215 | 2020-10-31 |
| 1386242147 | Busy Little Bee Speech Therapy | Speech-Language Pathologist | 2 Parmenter St, Cartersville, GA 30120-2569 | 2020-10-14 |
| 1033717749 | Sullivan Mccallon Friedrich | Speech-Language Pathologist | 413 W Montgomery Cross Rd, Savannah, GA 31406-3364 | 2020-10-14 |
| 1235737313 | Morgan Wojcik | Speech-Language Pathologist | 1777 N East Expy Ne Ste 120, Brookhaven, GA 30329-2475 | 2020-10-12 |
| 1699372953 | Sarah Elise Vaughn | Speech-Language Pathologist | 925 Osburn Rd, Chickamauga, GA 30707-2847 | 2020-10-08 |
| 1871190561 | Brian Tye | Speech-Language Pathologist | 1168 Chulio Rd Se, Rome, GA 30161-4084 | 2020-10-06 |
| 1538766761 | Camille Steiden | Speech-Language Pathologist | 300 W Wieuca Rd Ne Ste 200, Atlanta, GA 30342-3352 | 2020-10-01 |
| 1689281032 | Chit Chat Pediatric Therapy LLC | Speech-Language Pathologist | 97 Carter St, Soperton, GA 30457-2752 | 2020-09-29 |
| 1962019893 | Miriam Beth Rosenberg | Speech-Language Pathologist | 3843 Sweet Magnolia Dr, Gainesville, GA 30504-5949 | 2020-09-24 |
| 1093320244 | Brittany Jamison | Speech-Language Pathologist | 180 Horizon Drive, Dahlonega, GA 30533 | 2020-09-14 |
| Find all providers with the same taxonomy | ||||
| City | VILLA RICA |
| Zip Code | 30180 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.