Provider Demographics
NPI:1164103180
Name:THERAPY KREW, LLC
Entity Type:Organization
Organization Name:THERAPY KREW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CCC-SLP
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:317-586-0208
Mailing Address - Street 1:1 W 28TH ST APT 203
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-4779
Mailing Address - Country:US
Mailing Address - Phone:317-586-0208
Mailing Address - Fax:
Practice Address - Street 1:1 W 28TH ST APT 203
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-4779
Practice Address - Country:US
Practice Address - Phone:517-586-0208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty