Provider Demographics
NPI:1740911189
Name:SPEAK YOUR MIND LLC
Entity type:Organization
Organization Name:SPEAK YOUR MIND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DONOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:860-501-4223
Mailing Address - Street 1:163 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-4304
Mailing Address - Country:US
Mailing Address - Phone:860-501-4223
Mailing Address - Fax:
Practice Address - Street 1:495 GOLD STAR HWY STE 220
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-6230
Practice Address - Country:US
Practice Address - Phone:860-501-4223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-17
Last Update Date:2023-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty