=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619524311
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LET'S TALK SPEECH AND LANGUAGE THERAPY SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2019
-----------------------------------------------------
Last Update Date | 08/19/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 303 CENTERVILLE RD
-----------------------------------------------------
City | ANDERSON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29625-2650
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-968-1208
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 303 CENTERVILLE RD
-----------------------------------------------------
City | ANDERSON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29625-2650
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-968-1208
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DR.LYNNETTE LR POWELL/OWNER
-----------------------------------------------------
Name | DR. LYNNETTE LR POWELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 803-968-1208
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------