Provider Demographics
NPI:1548514748
Name:PERSONALIZED EDUCATIONAL RESOURCES, L.L.C.
Entity type:Organization
Organization Name:PERSONALIZED EDUCATIONAL RESOURCES, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH -LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PRINDIVILLE-JUROTICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-432-1211
Mailing Address - Street 1:12015 MANCHESTER RD
Mailing Address - Street 2:SUITE 57LL
Mailing Address - City:DES PERES
Mailing Address - State:MO
Mailing Address - Zip Code:63131-4423
Mailing Address - Country:US
Mailing Address - Phone:314-835-1505
Mailing Address - Fax:
Practice Address - Street 1:12015 MANCHESTER RD
Practice Address - Street 2:SUITE 57LL
Practice Address - City:DES PERES
Practice Address - State:MO
Practice Address - Zip Code:63131-4423
Practice Address - Country:US
Practice Address - Phone:314-835-1505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOHE01697235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty