Provider Demographics
NPI:1225121544
Name:SMALL TALK: SPEECH PATHOLOGY SERVICES, LLC
Entity Type:Organization
Organization Name:SMALL TALK: SPEECH PATHOLOGY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:GINGER
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:MSP, CCC-SLP
Authorized Official - Phone:803-270-4658
Mailing Address - Street 1:PO BOX 137
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29802-0137
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:118 PARK AVE SW
Practice Address - Street 2:SUITE 600
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-3835
Practice Address - Country:US
Practice Address - Phone:803-270-4658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12071099235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4154Medicaid
SCSA0428Medicaid