Basic Information
| Provider Information | |||||||||
| NPI: | 1740911189 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPEAK YOUR MIND LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 163 GLENWOOD AVE | ||||||||
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| City: | NEW LONDON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 063204304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605014223 | ||||||||
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| Practice Location | |||||||||
| Address1: | 808 STONINGTON RD FRNT STE 200 | ||||||||
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| City: | STONINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 063782530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605359922 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2022 | ||||||||
| LastUpdateDate: | 06/17/2022 | ||||||||
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| AuthorizedOfficialLastName: | DONOVAN | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8608605014 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | APRN | ||||||||
| NPICertificationDate: | 06/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SP0809X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health, Adult |
No ID Information.