Provider Demographics
NPI:1710357793
Name:SPRINGBOARD THERAPY SERVICES, INC
Entity Type:Organization
Organization Name:SPRINGBOARD THERAPY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VONNETTA
Authorized Official - Middle Name:JL
Authorized Official - Last Name:GIDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:SPEECH- LANGUAGE PAT
Authorized Official - Phone:202-725-1196
Mailing Address - Street 1:306 WINDING HILLS DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-4166
Mailing Address - Country:US
Mailing Address - Phone:202-725-1196
Mailing Address - Fax:601-385-3550
Practice Address - Street 1:306 WINDING HILLS DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-4166
Practice Address - Country:US
Practice Address - Phone:202-725-1196
Practice Address - Fax:601-385-3550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3895235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty