=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508281809
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPEAK SWALLOW THINK LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2014
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13 CENTER ST
-----------------------------------------------------
City | GULF BREEZE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32561-4370
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-602-3826
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2904 E GADSDEN ST
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32503-6429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-602-3826
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KYLE CHRISTINE LAKAS
-----------------------------------------------------
Credential | MS, CCC-SLP
-----------------------------------------------------
Telephone | 850-602-3826
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0700X
-----------------------------------------------------
Taxonomy Name | Hearing and Speech Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------