MEDICARE: GROW WITH ME PEDIATRIC THERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1851059737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GROW WITH ME PEDIATRIC THERAPY, LLC

Provider Business Mailing Address
First Line	:	420 CRESCENT DR
Second Line	:
City	:	CRESCENT
State	:	IA
Zip	:	51526-3607
Country	:	US
Telephone Number	:	402-885-9429
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 CRESCENT DR
Second Line	:
City	:	CRESCENT
State	:	IA
Zip	:	51526-3607
Country	:	US
Telephone Number	:	402-885-9429
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BAILEY FULMER
Credential	:	M.S., CCC-SLP
Telephone Number	:	402-885-9429

Provider Enumeration Date	:	12/07/2021
Last Update Date	:	05/02/2023

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Directions to “GROW WITH ME PEDIATRIC THERAPY, LLC ” Practice Location

Language	Start Address	Practice Location

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