| Entity Name: | SMALL TALK PEDIATRIC SLP, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 20 Jun 2014 (11 years ago) |
| Document Number: | L14000100490 |
| FEI/EIN Number | 47-1179082 |
| Address: | 514 NEWCASTLE DRIVE, Fort Walton Beach, FL, 32547, US |
| Mail Address: | 514 NEWCASTLE DRIVE, Fort Walton Beach, FL, 32547, US |
| ZIP code: | 32547 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1336544618 | 2014-10-28 | 2014-10-28 | 522 WINTHROP ST, FORT WALTON BEACH, FL, 325472679, US | 522 WINTHROP ST, FORT WALTON BEACH, FL, 325472679, US | |||||||||||||||||||||||||
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| Phone | +1 850-866-2286 |
| Fax | 8502442105 |
Authorized person
| Name | MRS. JENNIFER FLOWERS |
| Role | SPEECH LANGUAGE PATHOLOGIST/OWNER |
| Phone | 8508662286 |
Taxonomy
| Taxonomy Code | 235Z00000X - Speech-Language Pathologist |
| License Number | SA11376 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 009909500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| FLOWERS JENNIFER A | Agent | 48 Hemlock Drive, NW, Fort Walton Beach, FL, 32548 |
| Name | Role | Address |
|---|---|---|
| FLOWERS JENNIFER A | Owne | 48 Hemlock Drive, NW, Fort Walton Beach, FL, 32548 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-10-08 | 514 NEWCASTLE DRIVE, Fort Walton Beach, FL 32547 | No data |
| CHANGE OF MAILING ADDRESS | 2024-10-08 | 514 NEWCASTLE DRIVE, Fort Walton Beach, FL 32547 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-04-05 | 48 Hemlock Drive, NW, Fort Walton Beach, FL 32548 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-25 |
| ANNUAL REPORT | 2023-04-23 |
| ANNUAL REPORT | 2022-04-14 |
| ANNUAL REPORT | 2021-04-05 |
| ANNUAL REPORT | 2020-06-10 |
| ANNUAL REPORT | 2019-04-17 |
| ANNUAL REPORT | 2018-04-09 |
| ANNUAL REPORT | 2017-02-09 |
| ANNUAL REPORT | 2016-03-22 |
| ANNUAL REPORT | 2015-01-27 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
