Provider Demographics
NPI:1164693065
Name:KIDTALK,LLC
Entity Type:Organization
Organization Name:KIDTALK,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DALZELL
Authorized Official - Suffix:
Authorized Official - Credentials:MCD,CCC-SLP
Authorized Official - Phone:803-464-5850
Mailing Address - Street 1:630 SHIPWATCH DR
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29154-6087
Mailing Address - Country:US
Mailing Address - Phone:803-464-5850
Mailing Address - Fax:803-481-9549
Practice Address - Street 1:630 SHIPWATCH DR
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29154-6087
Practice Address - Country:US
Practice Address - Phone:803-464-5850
Practice Address - Fax:803-481-9549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3891261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1326149824OtherINDIVIDUAL NPI