Provider Demographics
NPI:1437819364
Name:PEDIATRIC PLACE, LLC
Entity Type:Organization
Organization Name:PEDIATRIC PLACE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:RATHERT
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:660-885-2394
Mailing Address - Street 1:210 S 2ND ST STE A
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735-2172
Mailing Address - Country:US
Mailing Address - Phone:660-885-2394
Mailing Address - Fax:660-383-1650
Practice Address - Street 1:210 S 2ND ST STE A
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MO
Practice Address - Zip Code:64735-2172
Practice Address - Country:US
Practice Address - Phone:660-885-2394
Practice Address - Fax:660-383-1650
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHATTERBOX SPEECH THERAPY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty