Provider Demographics
NPI:1487995692
Name:CHILDREN'S INNOVATIVE THERAPY GROUP, LLC
Entity type:Organization
Organization Name:CHILDREN'S INNOVATIVE THERAPY GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER AND DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HWANG
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:301-913-9009
Mailing Address - Street 1:4833 RUGBY AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-3035
Mailing Address - Country:US
Mailing Address - Phone:301-913-9009
Mailing Address - Fax:301-913-2939
Practice Address - Street 1:4833 RUGBY AVE STE 101
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3035
Practice Address - Country:US
Practice Address - Phone:301-913-9009
Practice Address - Fax:301-913-2939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04875261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech