MEDICARE: SPEAK EASY PEDIATRICS

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	225X00000X	Occupational Therapist
2	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1982155453
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPEAK EASY PEDIATRICS

Provider Business Mailing Address
First Line	:	1678 GERALDS DR
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-2135
Country	:	US
Telephone Number	:	614-940-4428
Fax Number	:	727-329-6603

Provider Business Practice Location Address
First Line	:	2632 CENTRAL AVE
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33712-1152
Country	:	US
Telephone Number	:	614-940-4428
Fax Number	:	727-329-6603

Authorized Official
Title or Position	:	SPEECH AND LANGUAGE PATHOLOGIST
Name	:	MRS. KATHERINE MARIA BESONEN
Credential	:	M.A., CCC-SLP
Telephone Number	:	614-940-4428

Provider Enumeration Date	:	10/20/2016
Last Update Date	:	06/05/2024

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Directions to “SPEAK EASY PEDIATRICS ” Practice Location

Language	Start Address	Practice Location

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