Provider Demographics
NPI:1396369369
Name:INNOVATIVE THERAPY SOLUTIONS, LLC
Entity Type:Organization
Organization Name:INNOVATIVE THERAPY SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, SLP
Authorized Official - Phone:307-299-5444
Mailing Address - Street 1:300 S GILLETTE AVE STE 1301
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-3733
Mailing Address - Country:US
Mailing Address - Phone:307-299-5444
Mailing Address - Fax:
Practice Address - Street 1:300 S GILLETTE AVE STE 1301
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3733
Practice Address - Country:US
Practice Address - Phone:307-299-5444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-04
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty