Provider Demographics
NPI:1689006686
Name:THERAKIDS, LLC
Entity Type:Organization
Organization Name:THERAKIDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:501-250-5166
Mailing Address - Street 1:PO BOX 957
Mailing Address - Street 2:
Mailing Address - City:HEBER SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72543-0957
Mailing Address - Country:US
Mailing Address - Phone:501-250-6068
Mailing Address - Fax:
Practice Address - Street 1:112 SOUTH 5TH ST.
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543-3816
Practice Address - Country:US
Practice Address - Phone:501-547-9994
Practice Address - Fax:888-898-8972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-01
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty