Healthcare Provider Details

I. General information

NPI: 1770930356
Provider Name (Legal Business Name): EAZY SPEECH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 05/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 LAKEVIEW DR
TEMPLE HILLS MD
20748-4934
US

IV. Provider business mailing address

4205 LAKEVIEW DR P.O. BOX 1433
TEMPLE HILLS MD
20748-4934
US

V. Phone/Fax

Practice location:
  • Phone: 301-848-3216
  • Fax: 301-848-3216
Mailing address:
  • Phone: 301-848-3216
  • Fax: 301-848-3216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberSLP000247
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberSLP000247
License Number StateDC

VIII. Authorized Official

Name: MS. LINDA JOYCE VAUGHN
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: M.S., CCC-SLP
Phone: 301-848-3216