Provider Demographics
NPI:1770029019
Name:KIDS PLACE LEARNING CENTER
Entity Type:Organization
Organization Name:KIDS PLACE LEARNING CENTER
Other - Org Name:KIDSPOT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:DEUTER
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:870-974-9114
Mailing Address - Street 1:1801 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-6155
Mailing Address - Country:US
Mailing Address - Phone:870-974-9114
Mailing Address - Fax:870-974-9184
Practice Address - Street 1:1823 GRANT AVE
Practice Address - Street 2:SUITE D AND E
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6155
Practice Address - Country:US
Practice Address - Phone:870-974-9114
Practice Address - Fax:870-974-9184
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIDS PLACE LEARNING CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-10
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
ARSP1713235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR198334724Medicaid