Provider Demographics
NPI:1760625792
Name:EARLY START EVALUATION THERAPY AND EDUCATIONAL SERVICES PLLC
Entity Type:Organization
Organization Name:EARLY START EVALUATION THERAPY AND EDUCATIONAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SLOCUM
Authorized Official - Suffix:
Authorized Official - Credentials:CCC/SLP
Authorized Official - Phone:518-885-5914
Mailing Address - Street 1:106 CONCORD DR
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-2304
Mailing Address - Country:US
Mailing Address - Phone:518-885-5914
Mailing Address - Fax:
Practice Address - Street 1:106 CONCORD DR
Practice Address - Street 2:
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-2304
Practice Address - Country:US
Practice Address - Phone:518-885-5914
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005888252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency