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General NPI Number Information
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NPI Number | 1821442690
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Entity Type | Organization
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Legal Business Name | SMALL TALK SPEECH & LANGAUGE THERAPY, INC
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Dates
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Enumeration Date | 04/19/2016
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Last Update Date | 04/19/2016
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Provider Practice Location Address
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Address Line | 2456 SW INDEPENDENCE RD
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34953-2415
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Country | US
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Telephone | 772-528-1842
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Fax | 888-899-5320
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Provider Business Mailing Address
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Address Line | 2456 SW INDEPENDENCE RD
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34953-2415
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Country | US
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Telephone | 772-528-1842
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Fax | 888-899-5320
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Authorized Official
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Title or Position | OWNER / SPEECH LANGUAGE PATHOLOGIST
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Name | MRS. SHANNON ELIZABETH CARVELLI
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Credential | M.A. CCC-SLP
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Telephone | 772-528-1842
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | FL
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