Provider Demographics
NPI:1093028797
Name:SMALL TALK PEDIATRIC THERAPY INC.
Entity Type:Organization
Organization Name:SMALL TALK PEDIATRIC THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:FISH
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:317-696-4160
Mailing Address - Street 1:2091 LIBERTY WAY DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7282
Mailing Address - Country:US
Mailing Address - Phone:317-696-4160
Mailing Address - Fax:317-885-8128
Practice Address - Street 1:2091 LIBERTY WAY DR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-7282
Practice Address - Country:US
Practice Address - Phone:317-696-4160
Practice Address - Fax:317-885-8128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003729A252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency