Provider Demographics
NPI:1669054441
Name:CHILDWORKS THERAPY CLINIC, PLLC
Entity type:Organization
Organization Name:CHILDWORKS THERAPY CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ABBIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GACKE
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:605-290-2939
Mailing Address - Street 1:4300 S LAKEPORT ST STE 106
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-9533
Mailing Address - Country:US
Mailing Address - Phone:605-290-2939
Mailing Address - Fax:605-305-3204
Practice Address - Street 1:4300 S LAKEPORT ST STE 106
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-9533
Practice Address - Country:US
Practice Address - Phone:605-290-2939
Practice Address - Fax:605-305-3204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-22
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty