Healthcare Provider Details

I. General information

NPI: 1992687529
Provider Name (Legal Business Name): SPEAK EASY ONLINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 07/24/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5202 MCCLELLAND BLVD
JOPLIN MO
65804
US

IV. Provider business mailing address

PO BOX 62
BOLIVAR MO
65613-0062
US

V. Phone/Fax

Practice location:
  • Phone: 417-781-4552
  • Fax: 417-777-7017
Mailing address:
  • Phone: 417-781-4552
  • Fax: 417-777-7017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: GAIL ROBERSON-FATINO
Title or Position: OWNER
Credential: LPC
Phone: 417-781-4552