Provider Demographics
NPI:1790950855
Name:KALEIDOSCOPE PEDIATRIC SPEECH THERAPY SPECIALISTS, LLC
Entity Type:Organization
Organization Name:KALEIDOSCOPE PEDIATRIC SPEECH THERAPY SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:YANDURA
Authorized Official - Last Name:KILAR
Authorized Official - Suffix:
Authorized Official - Credentials:MA,CCC-SLP
Authorized Official - Phone:812-340-0265
Mailing Address - Street 1:2536 W INDUSTRIAL PARK DR
Mailing Address - Street 2:SUITE 7
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-2635
Mailing Address - Country:US
Mailing Address - Phone:812-340-0265
Mailing Address - Fax:
Practice Address - Street 1:2536 W INDUSTRIAL PARK DR
Practice Address - Street 2:SUITE 7
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-2635
Practice Address - Country:US
Practice Address - Phone:812-340-0265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22002743A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty