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Organization
SUPER KIDS SPEECH THERAPY AND EDUCATIONAL SERVICES
Active
Organization
SUPER KIDS SPEECH THERAPY AND EDUCATIONAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIRA MEDINA TIENCKEN CCC-SLP (OWNER/DIRECTOR OF CLINICAL SRVICES)
(862) 812-1552
Entity
Organization
Contact information
Practice address
31 CHESTNUT TER, BLOOMFIELD, NJ 07003-4408
(862) 812-1552
Mailing address
31 CHESTNUT TER, BLOOMFIELD, NJ 07003-4408
(862) 812-1552
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
09/26/2024
Last updated
09/26/2024
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