Provider Demographics
NPI:1063789105
Name:KIDEOLOGY, LTD
Entity type:Organization
Organization Name:KIDEOLOGY, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CWIAK
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:702-508-0908
Mailing Address - Street 1:5120 S EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-2305
Mailing Address - Country:US
Mailing Address - Phone:702-508-0908
Mailing Address - Fax:702-508-9208
Practice Address - Street 1:5120 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-2305
Practice Address - Country:US
Practice Address - Phone:702-508-0908
Practice Address - Fax:702-508-9208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-17
Last Update Date:2011-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20111674178252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency