Provider Demographics
NPI:1174326508
Name:SPEAK LIFE IDENTITY LLC
Entity type:Organization
Organization Name:SPEAK LIFE IDENTITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER /CHW
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:CHW
Authorized Official - Phone:313-622-3780
Mailing Address - Street 1:2123 MOELLER AVE
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-9104
Mailing Address - Country:US
Mailing Address - Phone:313-622-3780
Mailing Address - Fax:
Practice Address - Street 1:2123 MOELLER AVE
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-9104
Practice Address - Country:US
Practice Address - Phone:313-622-3780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty