Provider Demographics
NPI:1710137500
Name:PRO-KIDS THERAPY, LLC
Entity Type:Organization
Organization Name:PRO-KIDS THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:CHATHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MCD, CCC-SLP
Authorized Official - Phone:501-823-0578
Mailing Address - Street 1:10515 W MARKHAM ST
Mailing Address - Street 2:SUITE I-3
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-2139
Mailing Address - Country:US
Mailing Address - Phone:501-823-0578
Mailing Address - Fax:501-823-0579
Practice Address - Street 1:10515 W MARKHAM ST
Practice Address - Street 2:SUITE I-3
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2139
Practice Address - Country:US
Practice Address - Phone:501-823-0578
Practice Address - Fax:501-823-0579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-29
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP1750235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty