Provider Demographics
NPI:1902371396
Name:IMPRINT PEDIATRIC THERAPY LLC.
Entity Type:Organization
Organization Name:IMPRINT PEDIATRIC THERAPY LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:STEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-606-0683
Mailing Address - Street 1:169 HILLTOP LN
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47448-7102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:169 HILLTOP LN
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:IN
Practice Address - Zip Code:47448-7102
Practice Address - Country:US
Practice Address - Phone:812-606-0683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty