Provider Demographics
NPI:1760211999
Name:SPEAKEASY HEALTH AND WELLNESS
Entity type:Organization
Organization Name:SPEAKEASY HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMMERLIN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:410-994-2383
Mailing Address - Street 1:PO BOX 372
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:MD
Mailing Address - Zip Code:21074-0372
Mailing Address - Country:US
Mailing Address - Phone:410-994-2383
Mailing Address - Fax:
Practice Address - Street 1:1814 BEL AIR RD STE 300
Practice Address - Street 2:
Practice Address - City:FALLSTON
Practice Address - State:MD
Practice Address - Zip Code:21047-2730
Practice Address - Country:US
Practice Address - Phone:410-994-2383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-27
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty