=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801436423
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SMALL TALK INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2020
-----------------------------------------------------
Last Update Date | 08/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 215 SAINT GEORGE ST
-----------------------------------------------------
City | ST AUGUSTINE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32084-4410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-733-8255
-----------------------------------------------------
Fax | 904-733-5034
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8777 SAN JOSE BLVD STE 701
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32217-4292
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-733-8255
-----------------------------------------------------
Fax | 904-733-5034
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JULIE FOLEY WATTS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 904-733-8255
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------