Provider Demographics
NPI:1154624419
Name:LEAPS AND BOUNDS THERAPY SERVICES, PLLC
Entity type:Organization
Organization Name:LEAPS AND BOUNDS THERAPY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KENGLA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:479-965-1424
Mailing Address - Street 1:416 LINCOLN DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:AR
Mailing Address - Zip Code:72933-9276
Mailing Address - Country:US
Mailing Address - Phone:479-965-4190
Mailing Address - Fax:
Practice Address - Street 1:404 SECOND ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:AR
Practice Address - Zip Code:72933-9125
Practice Address - Country:US
Practice Address - Phone:479-965-4190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#1724235Z00000X
ARSP#1675235Z00000X
ARSP#2262235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty