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General NPI Number Information
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NPI Number | 1760519375
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Entity Type | Organization
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Legal Business Name | INNOVATIVE THERAPEUTIC SERVICES, LLC
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 01/30/2013
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Provider Practice Location Address
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Address Line | 4 RAILROAD AVE
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City | SOMERSET
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State | NJ
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Zip | 08873-2724
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Country | US
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Telephone | 732-649-3439
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Fax | 732-649-3441
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Provider Business Mailing Address
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Address Line | 4 RAILROAD AVE
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City | SOMERSET
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State | NJ
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Zip | 08873-2724
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Country | US
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Telephone | 732-649-3439
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Fax | 732-649-3441
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Authorized Official
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Title or Position | PRESIDENT AND SPEECH PATHOLOGIST
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Name | MRS. GLORIA ANDERSON-BALLARD
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Credential | MA
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Telephone | 732-649-3439
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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 | 41YS00388300
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License Number State | NJ
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