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General NPI Number Information
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NPI Number | 1447249784
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Entity Type | Organization
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Legal Business Name | SMALL TALK INC
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Dates
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Enumeration Date | 10/19/2005
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Last Update Date | 03/12/2020
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Provider Practice Location Address
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Address Line | 8777 SAN JOSE BLVD STE 701
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City | JACKSONVILLE
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State | FL
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Zip | 32217-4292
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Country | US
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Telephone | 904-733-8255
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Fax | 904-733-5034
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Provider Business Mailing Address
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Address Line | 8777 SAN JOSE BLVD STE 701
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City | JACKSONVILLE
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State | FL
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Zip | 32217-4292
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Country | US
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Telephone | 904-733-8255
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Fax | 904-733-5034
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. JULIE F WATTS
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Credential | MS CCC-SLP
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Telephone | 904-993-2143
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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 | N/A
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License Number State | FL
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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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