Organization
CHILDS PLAY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIMBERLY RICHARDSON GUTIERREZ M.A., CCC/SLP (SPEECH-LANGUAGE PATHOLOGIST)
(307) 413-1829
Entity
Organization
Contact information
Practice address
73 NORTH MAIN, VICTOR, ID 83455
(208) 787-6900
Mailing address
PSC 485 BOX 351, FPO, AP 96321-0004
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP1143
ID
Other
Enumeration date
06/17/2010
Last updated
07/10/2012
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