Provider Demographics
NPI:1881026961
Name:SPEAK EASY
Entity Type:Organization
Organization Name:SPEAK EASY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAUGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:505-269-0677
Mailing Address - Street 1:PO BOX 7940
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87194-7940
Mailing Address - Country:US
Mailing Address - Phone:505-269-0677
Mailing Address - Fax:505-243-0492
Practice Address - Street 1:901 RIO GRANDE BLVD NW
Practice Address - Street 2:SUITE F-146
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87104-2057
Practice Address - Country:US
Practice Address - Phone:505-269-0677
Practice Address - Fax:505-243-0492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-31
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM845235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM43804306Medicaid