Provider Demographics
NPI:1689390718
Name:OUTGROW THERAPEUTICS
Entity Type:Organization
Organization Name:OUTGROW THERAPEUTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SPEECH-PATHOLOGIST, BCBA
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTIE
Authorized Official - Middle Name:F
Authorized Official - Last Name:KROL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC, SLP, BCBA
Authorized Official - Phone:845-548-4043
Mailing Address - Street 1:721 DOROTHY ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-1742
Mailing Address - Country:US
Mailing Address - Phone:845-548-4043
Mailing Address - Fax:
Practice Address - Street 1:721 DOROTHY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-1742
Practice Address - Country:US
Practice Address - Phone:845-548-4043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114204OtherSPEECH LICENSE
1932465986OtherNPI
3351OtherBACB