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Organization
MIRACLE KIDS SUCCESS ACADEMY, INC.
Active
Organization
MIRACLE KIDS SUCCESS ACADEMY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLY KELLER MCD, CCC-SLP (OWNER/PRESIDENT)
(870) 932-3600
Entity
Organization
Contact information
Practice address
1900 STILLWATER DR, JONESBORO, AR 72404-9119
(870) 932-3600
(870) 932-3611
Mailing address
1900 STILLWATER DR, JONESBORO, AR 72404-9119
(870) 932-3600
(870) 932-3611
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
—
NULL
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
NULL
261QR0400X
Rehabilitation Clinic/Center
Primary
—
NULL
Other
Enumeration date
11/10/2009
Last updated
11/30/2020
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