Provider Demographics
NPI:1598821308
Name:MILESTONES FOR KIDS SUCCESS, PC
Entity Type:Organization
Organization Name:MILESTONES FOR KIDS SUCCESS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:K
Authorized Official - Last Name:PUDERBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-673-4987
Mailing Address - Street 1:6224 PLYMOUTH CT
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-1785
Mailing Address - Country:US
Mailing Address - Phone:630-673-4987
Mailing Address - Fax:
Practice Address - Street 1:6224 PLYMOUTH CT
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-1785
Practice Address - Country:US
Practice Address - Phone:630-673-4987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty