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General NPI Number Information
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NPI Number | 1487955621
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Entity Type | Organization
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Legal Business Name | REACHING OUT LOUD, INC.
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Dates
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Enumeration Date | 11/04/2010
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Last Update Date | 12/14/2010
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Provider Practice Location Address
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Address Line | 10620 CORPORATE DRIVE SUITE C
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City | FORT WAYNE
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State | IN
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Zip | 46845
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Country | US
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Telephone | 260-450-3617
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Fax |
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Provider Business Mailing Address
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Address Line | 10620 CORPORATE DRIVE SUITE C
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City | FORT WAYNE
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State | IN
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Zip | 46845
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | JODI GOGOS
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Credential | M.S. CCC-SLP
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Telephone | 260-450-3617
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 22002999A
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License Number State | IN
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