Provider Demographics
NPI:1821236928
Name:PEDIATRIC PATHWAYS
Entity Type:Organization
Organization Name:PEDIATRIC PATHWAYS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC/SLP
Authorized Official - Phone:618-445-7747
Mailing Address - Street 1:RR 3 BOX 11
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:IL
Mailing Address - Zip Code:62806-9598
Mailing Address - Country:US
Mailing Address - Phone:618-445-3166
Mailing Address - Fax:618-445-3166
Practice Address - Street 1:RR 3 BOX 11
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:IL
Practice Address - Zip Code:62806-9598
Practice Address - Country:US
Practice Address - Phone:618-445-3166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency