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General NPI Number Information
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NPI Number | 1932861234
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Entity Type | Organization
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Legal Business Name | KIDS TALK PLACE LLC
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Dates
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Enumeration Date | 10/13/2021
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Last Update Date | 11/15/2022
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Provider Practice Location Address
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Address Line | 4100 S FERDON BLVD STE A1
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City | CRESTVIEW
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State | FL
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Zip | 32536-5287
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Country | US
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Telephone | 850-682-8388
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Fax |
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Provider Business Mailing Address
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Address Line | 4624 SUMMERDALE DR
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City | PACE
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State | FL
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Zip | 32571-1368
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Country | US
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Telephone | 850-994-3456
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARJORIE M SMITH
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Credential |
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Telephone | 850-982-5798
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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