Provider Demographics
NPI:1740601954
Name:KIDZ THERAPY ZONE
Entity Type:Organization
Organization Name:KIDZ THERAPY ZONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTIANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:214-509-6961
Mailing Address - Street 1:1101 CENTRAL EXPY S
Mailing Address - Street 2:SUITE 185
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-8062
Mailing Address - Country:US
Mailing Address - Phone:214-509-6961
Mailing Address - Fax:214-382-0943
Practice Address - Street 1:1101 CENTRAL EXPY S
Practice Address - Street 2:SUITE 185
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-8062
Practice Address - Country:US
Practice Address - Phone:214-509-6961
Practice Address - Fax:214-382-0943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106394235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty