Provider Demographics
NPI:1013224559
Name:SWEET TALK SPEECH THERAPY, LLC
Entity Type:Organization
Organization Name:SWEET TALK SPEECH THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:702-884-9945
Mailing Address - Street 1:8414 FARM RD
Mailing Address - Street 2:STE. 180338
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-8170
Mailing Address - Country:US
Mailing Address - Phone:702-884-9945
Mailing Address - Fax:702-396-6237
Practice Address - Street 1:8414 FARM RD
Practice Address - Street 2:STE. 180338
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-8170
Practice Address - Country:US
Practice Address - Phone:702-884-9945
Practice Address - Fax:702-396-6237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-03
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-748235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100500959Medicaid