=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275141442
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ENDLESS SPEECH AND LANGUAGE SERVICE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2020
-----------------------------------------------------
Last Update Date | 07/11/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 BEACON PKWY W STE 108D
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35209-3102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-677-5036
-----------------------------------------------------
Fax | 205-323-4226
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 100022
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35210-0022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-677-5036
-----------------------------------------------------
Fax | 205-352-3760
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH-LANGUAGE PATHOLOGIST
-----------------------------------------------------
Name | MRS. JASMINE RENAE CHRISTION
-----------------------------------------------------
Credential | M.S. CCC-SLP
-----------------------------------------------------
Telephone | 205-677-5036
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------