Provider Demographics
NPI:1447249784
Name:SMALL TALK INC
Entity type:Organization
Organization Name:SMALL TALK INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:F
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:904-993-2143
Mailing Address - Street 1:8777 SAN JOSE BLVD STE 701
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-4292
Mailing Address - Country:US
Mailing Address - Phone:904-733-8255
Mailing Address - Fax:904-733-5034
Practice Address - Street 1:8777 SAN JOSE BLVD STE 701
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-4292
Practice Address - Country:US
Practice Address - Phone:904-733-8255
Practice Address - Fax:904-733-5034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
FLN/A252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL901087100Medicaid
FL891087101Medicaid