Provider Demographics
NPI:1194141747
Name:KIDSZONE DEVELOPMENT AND LANGUAGE CENTER
Entity type:Organization
Organization Name:KIDSZONE DEVELOPMENT AND LANGUAGE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RIVERA TORO
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, SLP CCC MS
Authorized Official - Phone:787-413-8068
Mailing Address - Street 1:F8 CALLE 6
Mailing Address - Street 2:RIBERAS DEL RIO
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-413-8068
Mailing Address - Fax:787-731-3420
Practice Address - Street 1:1055 MARGINAL JF KENNEDY
Practice Address - Street 2:EDIFICIO ILA SUITE 411-A
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-1715
Practice Address - Country:US
Practice Address - Phone:787-413-8068
Practice Address - Fax:787-731-3420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-06
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2007235Z00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR456OtherSPEECH-LANGUAGE PATHOLOGIST LICENSE
PR1-16-21946OtherBACB CERTIFICATION AS BEHAVIOR ANALYST