| Indigo Therapy Services Llc | |
|
4900 Ohear Ave Ste 100 #24 North Charleston SC 29405-5091 | |
| (917) 362-3726 | |
| Not Available |
| Full Name | Indigo Therapy Services Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 4900 Ohear Ave Ste 100, North Charleston, South Carolina |
| Authorized Official Name and Position | Yaser Khaled Jaber (BCBA/CFO) |
| Authorized Official Contact | 9173623726 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Indigo Therapy Services Llc 4900 Ohear Ave Ste 100 #24 North Charleston SC 29405-5091 Ph: (917) 362-3726 | Indigo Therapy Services Llc 4900 Ohear Ave Ste 100 #24 North Charleston SC 29405-5091 Ph: (917) 362-3726 |
| NPI Number | 1205524089 |
|---|---|
| Provider Enumeration Date | 04/28/2023 |
| Last Update Date | 04/28/2023 |
| Certification Date | 04/28/2023 |
| Medicare PECOS PAC ID | 2961863519 |
|---|---|
| Medicare Enrollment ID | O20230731001479 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205524089 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
| Provider Name | Jacqueline Jaber |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1750526703 PECOS PAC ID: 6901832278 Enrollment ID: I20231127002824 |
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