1629485156 NPI number — SPEAK-EASY, LLC

Table of content: (NPI 1629485156)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629485156 NPI number — SPEAK-EASY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPEAK-EASY, 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:
1629485156
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1908 WHITNEY WOODS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JEFFERSON CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65101-2386
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-680-4913
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 EL MERCADO PLZ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JEFFERSON CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65109-6822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-680-4913
Provider Business Practice Location Address Fax Number:
888-977-2979
Provider Enumeration Date:
07/16/2014

Additional Information

Authorized Official

Authorized Official Last Name:
SCHWARTZ
Authorized Official First Name:
DANIELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER / SPEECH PATHOLOGIST
Authorized Official Telephone Number:
573-680-4913

Provider Taxonomy Codes

  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: MA6098 . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".




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