# KIDWORKS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992963813
- **Authorized official:** MR. CYNTHIA SUZANNE MANGAN (CO-OWNER)
- **Authorized official phone:** (219) 983-9675

## Contact information

- **Practice address:** 1120 S CALUMET RD STE 3, CHESTERTON, IN 46304-3286
- **Practice address phone:** (219) 983-9675
- **Practice address fax:** (219) 983-9675
- **Mailing address:** 1120 S CALUMET RD STE 3, CHESTERTON, IN 46304-3286
- **Mailing address phone:** (219) 983-9675
- **Mailing address fax:** (219) 983-9675

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 05008714A | IN | — |
| 225X00000X | Occupational Therapist | 31003944A | IN | Yes |
| 235Z00000X | Speech-Language Pathologist | 46001702A | IN | — |

## Other

- **Enumeration date:** 05/28/2008
- **Last updated:** 05/28/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 200837200A | MEDICAID FIRST STEPS GROUP \# | IN |
| 05 | — | 200861720A | — | IN |