Provider Demographics
NPI:1053095646
Name:LIFE SPEECH, LLC
Entity type:Organization
Organization Name:LIFE SPEECH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-235-1886
Mailing Address - Street 1:1320 PARK GLEN RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-8258
Mailing Address - Country:US
Mailing Address - Phone:912-665-4673
Mailing Address - Fax:
Practice Address - Street 1:2329 PROSSER RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37914-3324
Practice Address - Country:US
Practice Address - Phone:912-665-4673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-14
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ084552Medicaid