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General NPI Number Information
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NPI Number | 1093201808
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Entity Type | Organization
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Legal Business Name | THRIVE PEDIATRIC FEEDING THERAPY LLC
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Dates
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Enumeration Date | 07/04/2018
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Last Update Date | 07/04/2018
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Provider Practice Location Address
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Address Line | 4120 BELLEMEADE AVE
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City | EVANSVILLE
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State | IN
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Zip | 47714-0612
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Country | US
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Telephone | 812-470-6589
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Fax |
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Provider Business Mailing Address
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Address Line | 4120 BELLEMEADE AVE
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City | EVANSVILLE
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State | IN
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Zip | 47714-0612
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Country | US
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Telephone | 812-470-6589
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ELIZABETH PAGE CLAWSON
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Credential | PHD
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Telephone | 812-470-6589
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 20042290A
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License Number State | IN
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