Provider Demographics
NPI:1013637644
Name:EARLY SPROUT PEDIATRIC THERAPY
Entity Type:Organization
Organization Name:EARLY SPROUT PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/SLP
Authorized Official - Prefix:
Authorized Official - First Name:CAITLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BONI
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:224-595-4220
Mailing Address - Street 1:1600 MINK TRL
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-6070
Mailing Address - Country:US
Mailing Address - Phone:224-595-4220
Mailing Address - Fax:
Practice Address - Street 1:1600 MINK TRL
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:IL
Practice Address - Zip Code:60013-6070
Practice Address - Country:US
Practice Address - Phone:224-595-4220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-01
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech