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General NPI Number Information
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NPI Number | 1376080812
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Entity Type | Organization
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Legal Business Name | SPEAKEASY THERAPY FACTORY SPEECH LANGUAGE AND SWALLOWING SERVICES, LLC
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Dates
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Enumeration Date | 01/23/2017
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Last Update Date | 01/23/2017
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Provider Practice Location Address
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Address Line | 344 VIEW DR
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City | BLYTHEWOOD
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State | SC
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Zip | 29016-7252
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Country | US
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Telephone | 704-780-0211
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Fax | 803-470-4709
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Provider Business Mailing Address
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Address Line | 344 VIEW DR
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City | BLYTHEWOOD
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State | SC
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Zip | 29016-7252
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Country | US
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Telephone | 704-780-0211
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Fax | 803-470-4709
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Authorized Official
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Title or Position | SPEECH- LANGUAGE PATHOLOGIST
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Name | MRS. LATEKA KEGLER- TAYLOR
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Credential | M.A., CCC- SLP
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Telephone | 704-780-0211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | SC 5079
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License Number State | SC
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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 | SC 5079
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License Number State | SC
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