1336919554 NPI number — SPEECH FORMULA THERAPEUTICS, LLC

Table of content: LESLIE A. TALLMAN CPNP (NPI 1770743270)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336919554 NPI number — SPEECH FORMULA THERAPEUTICS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPEECH FORMULA THERAPEUTICS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336919554
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 292181
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29229-0037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-812-9751
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3015 CHIPPING LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29223-2012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-812-9751
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/08/2024

Additional Information

Authorized Official

Authorized Official Last Name:
WILSON
Authorized Official First Name:
A'KAILA
Authorized Official Middle Name:
MONAE
Authorized Official Title or Position:
SPEECH LANGUAGE PATHOLOGIST
Authorized Official Telephone Number:
843-812-9751

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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