MEDICARE: KIDZ CONNECTION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1467842211
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDZ CONNECTION

Provider Business Mailing Address
First Line	:	5307 JOHN F KENNEDY BLVD
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-6703
Country	:	US
Telephone Number	:	501-400-8663
Fax Number	:

Provider Business Practice Location Address
First Line	:	5307 JOHN F KENNEDY BLVD
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-6703
Country	:	US
Telephone Number	:	501-400-8663
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	TRACEE RAINEY
Credential	:	M.S.CCC-SLP
Telephone Number	:	501-400-8663

Provider Enumeration Date	:	02/02/2015
Last Update Date	:	02/02/2015

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Directions to “KIDZ CONNECTION ” Practice Location

Language	Start Address	Practice Location

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