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Organization
PEDIATRIC FEEDING THERAPY, S.C.
Active
Organization
PEDIATRIC FEEDING THERAPY, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY LONERGAN MS, CCC-SLP (SPEECH-LANGUAGE PATHOLOGIST)
(651) 485-1376
Entity
Organization
Contact information
Practice address
200 W MAIN ST STE 102, MOUNT HOREB, WI 53572-1962
(651) 485-1376
Mailing address
410 PARK VIEW DR, MOUNT HOREB, WI 53572-1635
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
05/14/2021
Last updated
05/14/2021
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