Provider Demographics
NPI:1356095681
Name:SERTOMA KIDS INC.
Entity Type:Organization
Organization Name:SERTOMA KIDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PLANK
Authorized Official - Suffix:
Authorized Official - Credentials:MACCC-SLP
Authorized Official - Phone:941-922-1028
Mailing Address - Street 1:2750 STICKNEY POINT RD STE 210
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-6000
Mailing Address - Country:US
Mailing Address - Phone:941-922-1028
Mailing Address - Fax:941-306-1805
Practice Address - Street 1:2750 STICKNEY POINT RD STE 210
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-6000
Practice Address - Country:US
Practice Address - Phone:941-922-1028
Practice Address - Fax:941-306-1805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-06
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty