Provider Demographics
NPI:1205564655
Name:SPEAKLIFE SPEECH, LANGUAGE, AND LITERACY SERVICES
Entity type:Organization
Organization Name:SPEAKLIFE SPEECH, LANGUAGE, AND LITERACY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:CAREN
Authorized Official - Last Name:CRAWFORD LACKEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, CCC-SLP
Authorized Official - Phone:850-445-6076
Mailing Address - Street 1:5561 BRADDOCK MILL WAY
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-0279
Mailing Address - Country:US
Mailing Address - Phone:850-445-6076
Mailing Address - Fax:
Practice Address - Street 1:732 INDIAN TRAIL FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-7685
Practice Address - Country:US
Practice Address - Phone:850-445-6076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty