Organization
KID EXPRESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY ANN FAIRRIS MA CCC-SLP (SPEECH-LANGUAGE PATHOLOGIST/OWNER)
(219) 805-8854
Entity
Organization
Contact information
Practice address
1473 LAKEWOOD LN, SCHERERVILLE, IN 46375-1093
(219) 805-8854
Mailing address
1473 LAKEWOOD LN, SCHERERVILLE, IN 46375-1093
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
22004186A
IN
Other
Enumeration date
01/29/2010
Last updated
01/29/2010
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