Organization
KIDS TALK PLACE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARJORIE M SMITH (OWNER)
(850) 982-5798
Entity
Organization
Contact information
Practice address
4100 S FERDON BLVD STE A1, CRESTVIEW, FL 32536-5287
(850) 682-8388
Mailing address
4624 SUMMERDALE DR, PACE, FL 32571-1368
(850) 994-3456
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
261QH0700X
Hearing and Speech Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
812245800
—
FL
05
—
889624100
—
FL
05
—
889624104
—
FL
01
—
9ZBKJ
BCBS
—
Enumeration date
10/13/2021
Last updated
11/15/2022
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