MEDICARE: SPEAK LIFE LEARNING ACADEMY 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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1982233417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPEAK LIFE LEARNING ACADEMY LLC

Provider Business Mailing Address
First Line	:	4335 TRUXTON PLACE DR
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-5438
Country	:	US
Telephone Number	:	419-917-3807
Fax Number	:

Provider Business Practice Location Address
First Line	:	4335 TRUXTON PLACE DR
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-5438
Country	:	US
Telephone Number	:	419-917-3807
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. KATHY DADZIE
Credential	:	CEO
Telephone Number	:	419-356-0189

Provider Enumeration Date	:	04/06/2020
Last Update Date	:	04/06/2020

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