Basic Information
| Provider Information | |||||||||
| NPI: | 1598821308 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MILESTONES FOR KIDS SUCCESS, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6224 PLYMOUTH CT | ||||||||
| Address2: | |||||||||
| City: | DOWNERS GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605161785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6306734987 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6224 PLYMOUTH CT | ||||||||
| Address2: | |||||||||
| City: | DOWNERS GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605161785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6306734987 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2006 | ||||||||
| LastUpdateDate: | 09/08/2021 | ||||||||
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| AuthorizedOfficialLastName: | PUDERBAUGH | ||||||||
| AuthorizedOfficialFirstName: | JANET | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6306734987 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 235Z00000X | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 252Y00000X | Y | Agencies | Early Intervention Provider Agency |
No ID Information.