Organization · NPI-2

Kids Talk Place LLC

Clinic/Center · Crestview, FL

NPI number1932861234
StatusActive
Last updated in NPPESNov 15, 2022

Details

NPI
1932861234
Entity type
Organization (NPI-2)
Legal business name
Kids Talk Place LLC
Organization subpart
No
Enumeration date
Oct 13, 2021
Certification date
Nov 15, 2022
Last updated
Nov 15, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261Q00000X Clinic/Center––Yes
261QH0700X Clinic/Center, Hearing and Speech––
261QM1300X Clinic/Center, Multi-Specialty––

Practice location

4100 S Ferdon Blvd Ste A1
Crestview, FL 32536-5287

Phone 850-682-8388

Mailing address

4624 Summerdale Dr
Pace, FL 32571-1368

Phone 850-994-3456

Authorized official

Marjorie M Smith
Owner
8509825798

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