| NPI | 1043686017 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLA C CLARK Speech Language Pathologist 800-994-1031 |
| Organization Subpart ? | No |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 2251P0200X Physical Therapist, Pediatrics | |
| 225A00000X Music Therapist | |
| 225XP0200X Occupational Therapist, Pediatrics | |
| 235Z00000X Speech-Language Pathologist, | |
| Enumeration Date | 2015-08-13 |
| Last Update Date | 2015-08-13 |