Organization
KIDWORKS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CYNTHIA SUZANNE MANGAN (CO-OWNER)
(219) 983-9675
Entity
Organization
Contact information
Practice address
1120 S CALUMET RD STE 3, CHESTERTON, IN 46304-3286
(219) 983-9675
(219) 983-9675
Mailing address
1120 S CALUMET RD STE 3, CHESTERTON, IN 46304-3286
(219) 983-9675
(219) 983-9675
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
05008714A
IN
225X00000X
Occupational Therapist
Primary
31003944A
IN
235Z00000X
Speech-Language Pathologist
46001702A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200837200A
MEDICAID FIRST STEPS GROUP #
IN
05
—
200861720A
—
IN
Enumeration date
05/28/2008
Last updated
05/28/2008
Update your record
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