Organization
PROGRESSIVE PEDIATRIC THERAPY SERVICES EARLY INTERVENTION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY QUIN PREJEAN MA, CCC-SLP (CLINIC DIRECTOR)
(850) 325-6301
Entity
Organization
Contact information
Practice address
1725 HERMITAGE BLVD, TALLAHASSEE, FL 32308-7709
(850) 325-6301
(850) 325-6302
Mailing address
1725 HERMITAGE BLVD, TALLAHASSEE, FL 32308-7709
(850) 325-6301
(850) 325-6302
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003247800
—
FL
Enumeration date
10/28/2016
Last updated
12/18/2020
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