Provider Demographics
NPI:1093987638
Name:KIDZ BIZ EARLY INTERVENTION
Entity Type:Organization
Organization Name:KIDZ BIZ EARLY INTERVENTION
Other - Org Name:TATIA GORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:TATIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-368-8333
Mailing Address - Street 1:4850 S LAKE PARK AVE APT 1708B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-2073
Mailing Address - Country:US
Mailing Address - Phone:773-368-8333
Mailing Address - Fax:773-538-4536
Practice Address - Street 1:4850 S LAKE PARK AVE APT 1708B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-2073
Practice Address - Country:US
Practice Address - Phone:773-368-8333
Practice Address - Fax:773-538-4536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency