Provider Demographics
NPI:1861768806
Name:KENAI KIDS THERAPY, INC
Entity type:Organization
Organization Name:KENAI KIDS THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:REISCHACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-260-7444
Mailing Address - Street 1:35105 KENAI SPUR HWY STE A
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7658
Mailing Address - Country:US
Mailing Address - Phone:907-260-7444
Mailing Address - Fax:907-260-7400
Practice Address - Street 1:48584 DEBRA CIR
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-9436
Practice Address - Country:US
Practice Address - Phone:907-776-5784
Practice Address - Fax:907-776-5786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK342355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty