Provider Demographics
NPI:1205106713
Name:SMALL WONDERS DEVELOPMENTAL SERVICES LLC
Entity type:Organization
Organization Name:SMALL WONDERS DEVELOPMENTAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SPECIAL INSTRUCTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZICKEFOOSE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:304-613-8630
Mailing Address - Street 1:99 EDMISTON WAY
Mailing Address - Street 2:STE 201
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-8916
Mailing Address - Country:US
Mailing Address - Phone:304-613-8630
Mailing Address - Fax:304-471-3441
Practice Address - Street 1:99 EDMISTON WAY
Practice Address - Street 2:STE 201
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-8916
Practice Address - Country:US
Practice Address - Phone:304-613-8630
Practice Address - Fax:304-471-3441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-01
Last Update Date:2012-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV4954252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency