MEDICARE: TALK SHOP SPEECH THERAPY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	21957	CA

General Provider Information

NPI Number	:	1164817110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TALK SHOP SPEECH THERAPY, INC.

Provider Business Mailing Address
First Line	:	85 CENTRAL AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94117-4114
Country	:	US
Telephone Number	:	650-468-6478
Fax Number	:

Provider Business Practice Location Address
First Line	:	2166 UNION ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94123-4004
Country	:	US
Telephone Number	:	650-468-6478
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	HANNAH KATE LIEBERKNECHT
Credential	:	CCC-SLP
Telephone Number	:	650-468-6478

Provider Enumeration Date	:	04/06/2015
Last Update Date	:	06/18/2024

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Directions to “TALK SHOP SPEECH THERAPY, INC. ” Practice Location

Language	Start Address	Practice Location

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