Provider Demographics
NPI:1528748720
Name:SWEET STARTS PEDIATRIC THERAPY, PLLC
Entity type:Organization
Organization Name:SWEET STARTS PEDIATRIC THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:MSED, CCC-SLP
Authorized Official - Phone:276-619-1649
Mailing Address - Street 1:18192 BLACK WOLF DR
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24211-7635
Mailing Address - Country:US
Mailing Address - Phone:276-619-1649
Mailing Address - Fax:
Practice Address - Street 1:18192 BLACK WOLF DR
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24211-7635
Practice Address - Country:US
Practice Address - Phone:276-619-1649
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty