=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215849922
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TINY TABLE TALK SPEECH AND FEEDING THERAPY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2026
-----------------------------------------------------
Last Update Date | 09/18/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6805 MOONLIGHT RD
-----------------------------------------------------
City | MIDLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79705-2459
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-209-7555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6805 MOONLIGHT RD
-----------------------------------------------------
City | MIDLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79705-2459
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-209-7555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/SPEECH LANGUAGE PATHOLOGIST
-----------------------------------------------------
Name | KELSEY HAINES
-----------------------------------------------------
Credential | CCC-SLP
-----------------------------------------------------
Telephone | 817-209-7555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------