Provider Demographics
NPI:1932415940
Name:SPEAK EASY REHABILITATION, PLLC
Entity Type:Organization
Organization Name:SPEAK EASY REHABILITATION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA-ROSE
Authorized Official - Middle Name:D
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:919-346-3350
Mailing Address - Street 1:PO BOX 2023
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-3023
Mailing Address - Country:US
Mailing Address - Phone:919-346-3350
Mailing Address - Fax:919-285-2554
Practice Address - Street 1:465 TIMBER MEADOW LAKE DR
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-4923
Practice Address - Country:US
Practice Address - Phone:919-346-3350
Practice Address - Fax:919-285-2554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7386235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7413035Medicaid