Provider Demographics
NPI:1114587870
Name:R.E.A.C.T. INITIATIVE, INC.
Entity Type:Organization
Organization Name:R.E.A.C.T. INITIATIVE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DIONNA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:LATIMER-HEARN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, CCC-SLP
Authorized Official - Phone:301-974-2871
Mailing Address - Street 1:2360 COMANCHE TRL
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8595
Mailing Address - Country:US
Mailing Address - Phone:301-974-2871
Mailing Address - Fax:
Practice Address - Street 1:2360 COMANCHE TRL
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-8595
Practice Address - Country:US
Practice Address - Phone:301-974-2871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-15
Last Update Date:2019-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3929598Medicaid