Provider Demographics
NPI:1851059737
Name:GROW WITH ME PEDIATRIC THERAPY, LLC
Entity Type:Organization
Organization Name:GROW WITH ME PEDIATRIC THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BAILEY
Authorized Official - Middle Name:
Authorized Official - Last Name:FULMER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:402-885-9429
Mailing Address - Street 1:420 CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:CRESCENT
Mailing Address - State:IA
Mailing Address - Zip Code:51526-3607
Mailing Address - Country:US
Mailing Address - Phone:402-885-9429
Mailing Address - Fax:
Practice Address - Street 1:420 CRESCENT DR
Practice Address - Street 2:
Practice Address - City:CRESCENT
Practice Address - State:IA
Practice Address - Zip Code:51526-3607
Practice Address - Country:US
Practice Address - Phone:402-885-9429
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-07
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty