Healthcare Provider Details

I. General information

NPI: 1821798786
Provider Name (Legal Business Name): KIDS TALK PLACE, LLC DBA PEDIATRIC THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2023
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 S FERDON BLVD STE A1
CRESTVIEW FL
32536-5287
US

IV. Provider business mailing address

1950 BISCAYNE BLVD
NAVARRE FL
32566-2925
US

V. Phone/Fax

Practice location:
  • Phone: 850-682-8388
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MEME SMITH
Title or Position: OWNER/ SPEECH LANGUAGE PATHOLOGIST
Credential:
Phone: 850-982-5798