Provider Demographics
NPI:1407362635
Name:KIDZ PALACE THERAPY LLC
Entity Type:Organization
Organization Name:KIDZ PALACE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:PLUNKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-476-0702
Mailing Address - Street 1:6520 BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-4732
Mailing Address - Country:US
Mailing Address - Phone:501-476-0702
Mailing Address - Fax:866-521-5461
Practice Address - Street 1:6520 BASELINE RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-4732
Practice Address - Country:US
Practice Address - Phone:501-476-0702
Practice Address - Fax:866-521-5461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-26
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty