Provider Demographics
NPI:1689430316
Name:SPEAK PLAY LOVE LLC
Entity Type:Organization
Organization Name:SPEAK PLAY LOVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:IVEY
Authorized Official - Last Name:RANDEL
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:318-393-2394
Mailing Address - Street 1:3331 MOORES GLEN DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-4070
Mailing Address - Country:US
Mailing Address - Phone:318-347-4961
Mailing Address - Fax:
Practice Address - Street 1:3331 MOORES GLEN DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-4070
Practice Address - Country:US
Practice Address - Phone:318-347-4961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-21
Last Update Date:2024-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty