=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053556001
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEE TALK, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2008
-----------------------------------------------------
Last Update Date | 12/10/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1615 BROWN AVE SUITE 2A
-----------------------------------------------------
City | COOKEVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38501-1445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-261-8007
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3788 BROOKWOOD DR
-----------------------------------------------------
City | COOKEVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38501-0720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-261-8007
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH PATHOLOGIST
-----------------------------------------------------
Name | MRS. RENE M CANFIELD
-----------------------------------------------------
Credential | CCC-SLP
-----------------------------------------------------
Telephone | 931-261-8007
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 3905
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 1538
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------