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General NPI Number Information
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NPI Number | 1710357793
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Entity Type | Organization
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Legal Business Name | SPRINGBOARD THERAPY SERVICES, INC
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Dates
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Enumeration Date | 10/02/2015
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Last Update Date | 10/02/2015
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Provider Practice Location Address
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Address Line | 306 WINDING HILLS DR
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City | CLINTON
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State | MS
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Zip | 39056-4166
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Country | US
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Telephone | 202-725-1196
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Fax | 601-385-3550
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Provider Business Mailing Address
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Address Line | 306 WINDING HILLS DR
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City | CLINTON
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State | MS
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Zip | 39056-4166
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Country | US
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Telephone | 202-725-1196
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Fax | 601-385-3550
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MRS. VONNETTA J.L GIDLEY
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Credential | SPEECH- LANGUAGE PAT
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Telephone | 202-725-1196
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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 | S3895
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License Number State | MS
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