Provider Demographics
NPI:1760519375
Name:INNOVATIVE THERAPEUTIC SERVICES, LLC
Entity Type:Organization
Organization Name:INNOVATIVE THERAPEUTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND SPEECH PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON-BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:732-649-3439
Mailing Address - Street 1:4 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-2724
Mailing Address - Country:US
Mailing Address - Phone:732-649-3439
Mailing Address - Fax:732-649-3441
Practice Address - Street 1:4 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-2724
Practice Address - Country:US
Practice Address - Phone:732-649-3439
Practice Address - Fax:732-649-3441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00388300252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency