Provider Demographics
NPI:1154914117
Name:THRIVE KIDS LLC
Entity type:Organization
Organization Name:THRIVE KIDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:L
Authorized Official - Last Name:JENN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-716-8200
Mailing Address - Street 1:5117 FLAD AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-3621
Mailing Address - Country:US
Mailing Address - Phone:608-716-8200
Mailing Address - Fax:
Practice Address - Street 1:5117 FLAD AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-3621
Practice Address - Country:US
Practice Address - Phone:608-716-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty