| Kidspace Therapy, Llc | |
|
2145 Tibbetts Dr Ste A Longview WA 98632-4211 | |
| (360) 560-1972 | |
| (360) 703-3452 |
| Full Name | Kidspace Therapy, Llc |
|---|---|
| Speciality | Clinic/center - Developmental Disabilities |
| Location | 2145 Tibbetts Dr Ste A, Longview, Washington |
| Authorized Official Name and Position | Leslie Kay Wolff (OWNER) |
| Authorized Official Contact | 3605601972 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kidspace Therapy, Llc 2145 Tibbetts Dr Ste A Longview WA 98632-4211 Ph: (360) 560-1972 | Kidspace Therapy, Llc 2145 Tibbetts Dr Ste A Longview WA 98632-4211 Ph: (360) 560-1972 |
| NPI Number | 1184019184 |
|---|---|
| Provider Enumeration Date | 04/06/2015 |
| Last Update Date | 07/15/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184019184 | NPI | - | NPPES |
| 1801921531 | Other | WA | INDIVIDUAL NPI |
| 2043730 | Medicaid | WA | |
| 603464065 | Other | WA | UBI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | OT00001294 (Washington) | Secondary |
| 261QD1600X | Clinic/center - Developmental Disabilities | 603464065 (Washington) | Primary |
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