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General NPI Number Information
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NPI Number | 1326744467
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Entity Type | Organization
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Legal Business Name | SPEAKEASY THERAPIES & FITNESS LLC
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Dates
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Enumeration Date | 01/31/2023
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Last Update Date | 04/04/2024
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Provider Practice Location Address
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Address Line | 2718 SUTTON BLVD
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City | MAPLEWOOD
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State | MO
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Zip | 63143-3036
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Country | US
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Telephone | 314-246-0751
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Fax | 314-754-9926
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Provider Business Mailing Address
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Address Line | 2718 SUTTON BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63143-3036
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Country | US
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Telephone | 314-348-7327
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Fax | 314-754-9926
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CELIA G MONTES-KOLENCE
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Credential | MS-CCC, SLP
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Telephone | 314-348-7327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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