Provider Demographics
NPI:1922505437
Name:SMALL TALK CHESCO, LLC
Entity Type:Organization
Organization Name:SMALL TALK CHESCO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:CONSTANTINIDIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SP
Authorized Official - Phone:267-265-1642
Mailing Address - Street 1:931 BRITTNEY TER
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-4423
Mailing Address - Country:US
Mailing Address - Phone:267-265-1642
Mailing Address - Fax:
Practice Address - Street 1:213 POTTSTOWN PIKE
Practice Address - Street 2:
Practice Address - City:CHESTER SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:19425-9570
Practice Address - Country:US
Practice Address - Phone:267-265-1642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-11
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007808261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA=========OtherBLUE CROSS BLUE SHIELD
PA=========Medicaid