Provider Demographics
NPI:1013646538
Name:SPEAK EASY OF THE TREASURE COAST, LLC
Entity Type:Organization
Organization Name:SPEAK EASY OF THE TREASURE COAST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KALINOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-332-1112
Mailing Address - Street 1:3591 SW BIMINI CIR N
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-1301
Mailing Address - Country:US
Mailing Address - Phone:772-332-1112
Mailing Address - Fax:
Practice Address - Street 1:3591 SW BIMINI CIR N
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-1301
Practice Address - Country:US
Practice Address - Phone:772-332-1112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1629639463Medicaid