Healthcare Provider Details

I. General information

NPI: 1114549664
Provider Name (Legal Business Name): SMALL TALK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9803 OLD SAINT AUGUSTINE RD STE 7
JACKSONVILLE FL
32257-8845
US

IV. Provider business mailing address

8777 SAN JOSE BLVD STE 701
JACKSONVILLE FL
32217-4292
US

V. Phone/Fax

Practice location:
  • Phone: 904-733-8255
  • Fax: 904-733-5034
Mailing address:
  • Phone: 904-733-8255
  • Fax: 904-733-5034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: JULIE FOLEY WATTS
Title or Position: PRESIDENT
Credential:
Phone: 904-733-8255