| NPI | 1053642173 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY ANN FAIRRIS Speech Language Pathologist/Owner 219-805-8854 |
| Organization Subpart ? | No |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency (Licence: IN 22004186A) |
| Enumeration Date | 2010-01-29 |
| Last Update Date | 2010-01-29 |