Provider Demographics
NPI:1629485156
Name:SPEAK-EASY, LLC
Entity Type:Organization
Organization Name:SPEAK-EASY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER / SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:573-680-4913
Mailing Address - Street 1:1908 WHITNEY WOODS DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-2386
Mailing Address - Country:US
Mailing Address - Phone:573-680-4913
Mailing Address - Fax:
Practice Address - Street 1:2725 MERCHANTS DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-1161
Practice Address - Country:US
Practice Address - Phone:573-680-4913
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6098OtherMEDICARE PTAN