Provider Demographics
NPI:1164251849
Name:JACOB'S LADDER PEDIATRIC REHAB CENTER
Entity type:Organization
Organization Name:JACOB'S LADDER PEDIATRIC REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIANN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-764-4888
Mailing Address - Street 1:1595 S CALUMET RD STE 3
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-2389
Mailing Address - Country:US
Mailing Address - Phone:219-764-4888
Mailing Address - Fax:219-898-4258
Practice Address - Street 1:1595 S CALUMET RD STE 3
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-2389
Practice Address - Country:US
Practice Address - Phone:219-764-4888
Practice Address - Fax:219-898-4258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty