Healthcare Provider Details

I. General information

NPI: 1083080410
Provider Name (Legal Business Name): SPEAK LIFE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2015
Last Update Date: 08/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10606 WARWICK BLVD STE B
NEWPORT NEWS VA
23601-3709
US

IV. Provider business mailing address

10606 WARWICK BLVD STE B
NEWPORT NEWS VA
23601-3709
US

V. Phone/Fax

Practice location:
  • Phone: 757-927-3162
  • Fax:
Mailing address:
  • Phone: 757-927-3162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number2202006657
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number2202006657
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number2202006657
License Number StateVA

VIII. Authorized Official

Name: CHRISTINE C COOPER
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential:
Phone: 757-927-3162