Healthcare Provider Details

I. General information

NPI: 1477241073
Provider Name (Legal Business Name): HOMEGROWN KIDS THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 SW ORALABOR RD STE B
ANKENY IA
50023-7147
US

IV. Provider business mailing address

511 NE VISTA LN
ANKENY IA
50021-6636
US

V. Phone/Fax

Practice location:
  • Phone: 515-216-0091
  • Fax: 515-655-8521
Mailing address:
  • Phone:
  • Fax: 515-655-8521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MACKENZIE THOMAS
Title or Position: OWNER
Credential:
Phone: 515-290-8658