| Organization Name: | COUNTRY KIDS INC. |
| NPI Number: | 1497851265 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LISA KAFKA (EXECUTIVE DIRECTOR) |
| Mailing Address: | 1142 Orlando Dr De Pere |
| State: | WI US |
| Postal Code: | 541159484 |
| Phone Number: | 9203390700 |
| Fax Number: | 9203300278 |
| NPI Enumeration Date: | 09/16/2006 |
| NPI Last Update Date: | 08/28/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |