Provider Demographics
NPI:1124279757
Name:SMALL WONDERS EARLY INTERVENTION SERVICES, INC.
Entity type:Organization
Organization Name:SMALL WONDERS EARLY INTERVENTION SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:VAUGHN
Authorized Official - Last Name:WASHBURN
Authorized Official - Suffix:
Authorized Official - Credentials:M ED
Authorized Official - Phone:607-798-8056
Mailing Address - Street 1:1364 REYNOLDS RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-4837
Mailing Address - Country:US
Mailing Address - Phone:607-584-0709
Mailing Address - Fax:607-770-1446
Practice Address - Street 1:1364 REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-4837
Practice Address - Country:US
Practice Address - Phone:607-584-0709
Practice Address - Fax:607-770-1446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-01
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency