Provider Demographics
NPI:1114204567
Name:THERAPY TIME FOR KIDS LLC
Entity Type:Organization
Organization Name:THERAPY TIME FOR KIDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:LACROIX
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC SLP
Authorized Official - Phone:920-840-3033
Mailing Address - Street 1:W2544 BUCHANAN RD
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-8751
Mailing Address - Country:US
Mailing Address - Phone:920-840-3033
Mailing Address - Fax:888-883-1209
Practice Address - Street 1:W2544 BUCHANAN RD
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-8751
Practice Address - Country:US
Practice Address - Phone:920-840-3033
Practice Address - Fax:888-883-1209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2292235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty