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General NPI Number Information
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NPI Number | 1194034603
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Entity Type | Organization
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Legal Business Name | SPEAKEASY THERAPY, PLLC
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Dates
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Enumeration Date | 09/30/2010
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Last Update Date | 09/30/2010
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Provider Practice Location Address
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Address Line | 8800 BUCKEY CT
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City | LEWISVILLE
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State | NC
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Zip | 27023-7745
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Country | US
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Telephone | 336-946-2493
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Fax | 336-450-2637
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Provider Business Mailing Address
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Address Line | 8800 BUCKEY CT
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City | LEWISVILLE
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State | NC
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Zip | 27023-7745
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Country | US
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Telephone | 336-946-2493
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Fax | 336-450-2637
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | MS. JULIE CASEY
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Credential | M.S., CCC-SLP
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Telephone | 336-946-2493
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 4582
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License Number State | NC
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