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General NPI Number Information
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NPI Number | 1982155453
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Entity Type | Organization
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Legal Business Name | SPEAK EASY PEDIATRICS
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Dates
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Enumeration Date | 10/20/2016
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 2632 CENTRAL AVE
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City | ST PETERSBURG
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State | FL
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Zip | 33712-1152
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Country | US
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Telephone | 614-940-4428
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Fax | 727-329-6603
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Provider Business Mailing Address
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Address Line | 1678 GERALDS DR
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City | BRENTWOOD
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State | TN
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Zip | 37027-2135
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Country | US
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Telephone | 614-940-4428
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Fax | 727-329-6603
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Authorized Official
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Title or Position | SPEECH AND LANGUAGE PATHOLOGIST
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Name | MRS. KATHERINE MARIA BESONEN
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Credential | M.A., CCC-SLP
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Telephone | 614-940-4428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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