| Kids Talk Place LLC | |
|
4100 S Ferdon Blvd Ste A1 Crestview FL 32536-5287 | |
| (850) 682-8388 | |
| Not Available |
| Full Name | Kids Talk Place LLC |
|---|---|
| Speciality | Clinic/center |
| Location | 4100 S Ferdon Blvd Ste A1, Crestview, Florida |
| Authorized Official Name and Position | Marjorie M Smith (OWNER) |
| Authorized Official Contact | 8509825798 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kids Talk Place LLC 4624 Summerdale Dr Pace FL 32571-1368 Ph: (850) 994-3456 | Kids Talk Place LLC 4100 S Ferdon Blvd Ste A1 Crestview FL 32536-5287 Ph: (850) 682-8388 |
| NPI Number | 1932861234 |
|---|---|
| Provider Enumeration Date | 10/13/2021 |
| Last Update Date | 11/15/2022 |
| Certification Date | 11/15/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932861234 | NPI | - | NPPES |
| 889624104 | Medicaid | FL | |
| 889624100 | Medicaid | FL | |
| 9ZBKJ | Other | BCBS | |
| 812245800 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | () | Primary |
| 261QH0700X | Clinic/center - Hearing And Speech | () | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | () | Secondary |
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