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General NPI Number Information
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NPI Number | 1174326508
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Entity Type | Organization
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Legal Business Name | SPEAK LIFE IDENTITY LLC
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Dates
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Enumeration Date | 03/31/2025
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 2123 MOELLER AVE
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City | YPSILANTI
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State | MI
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Zip | 48198-9104
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Country | US
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Telephone | 313-622-3780
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Fax |
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Provider Business Mailing Address
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Address Line | 2123 MOELLER AVE
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City | YPSILANTI
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State | MI
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Zip | 48198-9104
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Country | US
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Telephone | 313-622-3780
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Fax |
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Authorized Official
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Title or Position | OWNER /CHW
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Name | TODD A WILLIAMS
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Credential | CHW
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Telephone | 313-622-3780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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