Provider Demographics
NPI:1013589829
Name:AMAZING BRAINS THERAPY, LLC
Entity Type:Organization
Organization Name:AMAZING BRAINS THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST / OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KASHA
Authorized Official - Middle Name:MUSTIN
Authorized Official - Last Name:HEREK
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:757-304-6282
Mailing Address - Street 1:2706 ETON RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-4132
Mailing Address - Country:US
Mailing Address - Phone:757-304-6282
Mailing Address - Fax:855-610-2253
Practice Address - Street 1:2706 ETON RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4132
Practice Address - Country:US
Practice Address - Phone:757-304-6282
Practice Address - Fax:855-610-2253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-12
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty