1124638572 NPI number — TALK WITH ME SPEECH THERAPY/HABLA CONMIGO TERAPIA DEL HABLA, LLC

Table of content: (NPI 1124638572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124638572 NPI number — TALK WITH ME SPEECH THERAPY/HABLA CONMIGO TERAPIA DEL HABLA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TALK WITH ME SPEECH THERAPY/HABLA CONMIGO TERAPIA DEL HABLA, 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:
1124638572
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6080 LAKEVIEW RD APT 1907
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARNER ROBINS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31088-9114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-818-3726
Provider Business Mailing Address Fax Number:
478-245-9082

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6080 LAKEVIEW RD APT 1907
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARNER ROBINS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31088-9114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-818-3726
Provider Business Practice Location Address Fax Number:
478-245-9082
Provider Enumeration Date:
07/31/2020

Additional Information

Authorized Official

Authorized Official Last Name:
WOHLFELD
Authorized Official First Name:
CASIPHIA
Authorized Official Middle Name:
Authorized Official Title or Position:
BILINGUAL SPEECH-LANGUAGE/OWNER
Authorized Official Telephone Number:
910-818-3726

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)

  • Identifier: 14456889 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 003216196A , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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