Healthcare Provider Details

I. General information

NPI: 1780313767
Provider Name (Legal Business Name): SPEAKEASY SPEECH THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 12/21/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 MOTT AVE STE 207 OFFICE 2
NORWALK CT
06850-3338
US

IV. Provider business mailing address

399 MAIN AVE APT 315
NORWALK CT
06851-1568
US

V. Phone/Fax

Practice location:
  • Phone: 203-293-7672
  • Fax: 914-470-6200
Mailing address:
  • Phone: 914-882-4583
  • Fax: 914-470-6200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: TONIA M CLAYE LACKRAN
Title or Position: SLP
Credential:
Phone: 914-882-4583