Provider Demographics
NPI:1649838277
Name:SMALL TALK SPEECH THERAPY, INC.
Entity type:Organization
Organization Name:SMALL TALK SPEECH THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:PFINGSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:618-550-8213
Mailing Address - Street 1:215 EUGENIA DR
Mailing Address - Street 2:
Mailing Address - City:SMITHTON
Mailing Address - State:IL
Mailing Address - Zip Code:62285-1425
Mailing Address - Country:US
Mailing Address - Phone:618-550-8213
Mailing Address - Fax:618-222-1520
Practice Address - Street 1:215 EUGENIA DR
Practice Address - Street 2:
Practice Address - City:SMITHTON
Practice Address - State:IL
Practice Address - Zip Code:62285-1425
Practice Address - Country:US
Practice Address - Phone:618-550-8213
Practice Address - Fax:618-222-1520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty