MEDICARE: EASY TALK PEDIATRICS, 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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1689288581
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASY TALK PEDIATRICS, LLC

Provider Business Mailing Address
First Line	:	1643B SAVANNAH HWY # 202
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-6256
Country	:	US
Telephone Number	:	843-580-8729
Fax Number	:	907-308-6754

Provider Business Practice Location Address
First Line	:	1643B SAVANNAH HWY # 202
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-6256
Country	:	US
Telephone Number	:	843-580-8729
Fax Number	:	907-308-6754

Authorized Official
Title or Position	:	FOUNDER/SLP
Name	:	REBECCA HORSEY
Credential	:	MCD, CCC-SLP
Telephone Number	:	843-580-8729

Provider Enumeration Date	:	09/08/2020
Last Update Date	:	09/08/2020

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Directions to “EASY TALK PEDIATRICS, LLC ” Practice Location

Language	Start Address	Practice Location

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