Healthcare Provider Details

I. General information

NPI: 1790200202
Provider Name (Legal Business Name): SMALL TALK SPEECH & LANGUAGE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 W CAYUSE CREEK DR STE 100
MERIDIAN ID
83646-6135
US

IV. Provider business mailing address

1508 W CAYUSE CREEK DR STE 100
MERIDIAN ID
83646-6135
US

V. Phone/Fax

Practice location:
  • Phone: 208-996-0552
  • Fax: 208-496-9281
Mailing address:
  • Phone: 208-996-0552
  • Fax: 208-496-9281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP-2299
License Number StateID

VIII. Authorized Official

Name: KAREN HIBBS
Title or Position: OWNER
Credential:
Phone: 208-996-0552