MEDICARE: EAZY SPEECH, 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	313M00000X	Nursing Facility/Intermediate Care Facility	SLP000247	DC
2	251E00000X	Home Health Agency	SLP000247	DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1598957995	OTHER	GA	NATIONAL PROVIDER IDENTIFICATION

General Provider Information

NPI Number	:	1770930356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAZY SPEECH, LLC

Provider Business Mailing Address
First Line	:	4205 LAKEVIEW DR
Second Line	:	P.O. BOX 1433
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-4934
Country	:	US
Telephone Number	:	301-848-3216
Fax Number	:	301-848-3216

Provider Business Practice Location Address
First Line	:	4205 LAKEVIEW DR
Second Line	:
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-4934
Country	:	US
Telephone Number	:	301-848-3216
Fax Number	:	301-848-3216

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLOGIST
Name	:	MS. LINDA JOYCE VAUGHN
Credential	:	M.S., CCC-SLP
Telephone Number	:	301-848-3216

Provider Enumeration Date	:	05/24/2016
Last Update Date	:	05/24/2016

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Directions to “EAZY SPEECH, LLC ” Practice Location

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