MEDICARE: SPEAK LIFE SPEECH THERAPY, LLC

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	261QH0700X	Hearing and Speech Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3835	OTHER	KS	KANSAS STATE LICENSE

General Provider Information

NPI Number	:	1558979997
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPEAK LIFE SPEECH THERAPY, LLC

Provider Business Mailing Address
First Line	:	352 E CHEYENNE CT
Second Line	:
City	:	KECHI
State	:	KS
Zip	:	67067-8629
Country	:	US
Telephone Number	:	913-396-1711
Fax Number	:

Provider Business Practice Location Address
First Line	:	352 E CHEYENNE CT
Second Line	:
City	:	KECHI
State	:	KS
Zip	:	67067-8629
Country	:	US
Telephone Number	:	913-396-1711
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EMILY MCDONOUGH
Credential	:	SLP
Telephone Number	:	913-396-1711

Provider Enumeration Date	:	07/22/2020
Last Update Date	:	07/22/2020

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