Provider Demographics
NPI:1093112872
Name:PLAYFUL START THERAPY, LLC.
Entity Type:Organization
Organization Name:PLAYFUL START THERAPY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-660-9062
Mailing Address - Street 1:5959 RENKEN RD
Mailing Address - Street 2:
Mailing Address - City:DORSEY
Mailing Address - State:IL
Mailing Address - Zip Code:62021-1607
Mailing Address - Country:US
Mailing Address - Phone:618-660-9062
Mailing Address - Fax:618-377-9028
Practice Address - Street 1:5959 RENKEN RD
Practice Address - Street 2:
Practice Address - City:DORSEY
Practice Address - State:IL
Practice Address - Zip Code:62021-1607
Practice Address - Country:US
Practice Address - Phone:618-660-9062
Practice Address - Fax:618-377-9028
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PLAYFUL START THERAPY, LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-22
Last Update Date:2014-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency