| NPI | 1053967273 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUCKY FERGUSON Managing Partner 224-201-8769 |
| Organization Subpart ? | No |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 171R00000X Interpreter | |
| 225100000X Physical Therapist | |
| 225X00000X Occupational Therapist | |
| 235Z00000X Speech-Language Pathologist, | |
| Enumeration Date | 2019-08-13 |
| Last Update Date | 2024-10-24 |