1770930356 NPI number — EAZY SPEECH, LLC

Table of content: (NPI 1770930356)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770930356 NPI number — EAZY SPEECH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAZY SPEECH, 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:
1770930356
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4205 LAKEVIEW DR
Provider Second Line Business Mailing Address:
P.O. BOX 1433
Provider Business Mailing Address City Name:
TEMPLE HILLS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20748-4934
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-848-3216
Provider Business Mailing Address Fax Number:
301-848-3216

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4205 LAKEVIEW DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEMPLE HILLS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20748-4934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-848-3216
Provider Business Practice Location Address Fax Number:
301-848-3216
Provider Enumeration Date:
05/24/2016

Additional Information

Authorized Official

Authorized Official Last Name:
VAUGHN
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
JOYCE
Authorized Official Title or Position:
SPEECH LANGUAGE PATHOLOGIST
Authorized Official Telephone Number:
301-848-3216

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  SLP000247 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 313M00000X , with the licence number: SLP000247 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1598957995 . This is a "NATIONAL PROVIDER IDENTIFICATION" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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