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General NPI Number Information
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NPI Number | 1487066940
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Entity Type | Organization
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Legal Business Name | KIDZSPEECH, LLC
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Dates
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Enumeration Date | 06/02/2014
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Last Update Date | 06/02/2014
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Provider Practice Location Address
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Address Line | 1909 TREE LINE CT
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City | WAUKESHA
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State | WI
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Zip | 53188-2655
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Country | US
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Telephone | 414-507-9181
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Fax |
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Provider Business Mailing Address
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Address Line | W238N1690 ROCKWOOD DR SUITE 500
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City | WAUKESHA
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State | WI
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Zip | 53188-1151
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Country | US
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Telephone | 414-507-9181
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KIRSTEN CERRONI
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Credential |
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Telephone | 414-507-9181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 1083-154
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License Number State | WI
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