Organization
PEDIATRIC SPECIALTY ASSOCIATES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA HOLTZ (OWNER)
(317) 405-9016
Entity
Organization
Contact information
Practice address
6437 RUCKER RD, SUITE D, INDIANAPOLIS, IN 46220-4885
(317) 405-9016
Mailing address
6437 RUCKER RD, SUITE D, INDIANAPOLIS, IN 46220-4885
(317) 405-9016
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
22005410A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22005410A
INDIANA SPEECH LANGUAGE LICENSE
IN
Enumeration date
05/09/2015
Last updated
05/09/2015
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