Provider Demographics
NPI:1770930356
Name:EAZY SPEECH, LLC
Entity type:Organization
Organization Name:EAZY SPEECH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:301-848-3216
Mailing Address - Street 1:4205 LAKEVIEW DR
Mailing Address - Street 2:P.O. BOX 1433
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-4934
Mailing Address - Country:US
Mailing Address - Phone:301-848-3216
Mailing Address - Fax:301-848-3216
Practice Address - Street 1:4205 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-4934
Practice Address - Country:US
Practice Address - Phone:301-848-3216
Practice Address - Fax:301-848-3216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCSLP000247313M00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1598957995OtherNATIONAL PROVIDER IDENTIFICATION