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Organization
CENTER FOR LANGUAGE ACQUISITION AND SOCIAL SKILLS INTERVENTION, LLC
Active
Organization
CENTER FOR LANGUAGE ACQUISITION AND SOCIAL SKILLS INTERVENTION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIFFANY KODAK PH.D. (EXECUTIVE DIRECTOR)
(402) 319-3770
Entity
Organization
Contact information
Practice address
8239 W HILLVIEW DR, MEQUON, WI 53097-3205
(402) 319-3770
Mailing address
8239 W HILLVIEW DR, MEQUON, WI 53097-3205
(402) 319-3770
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
86-140
WI
103TC2200X
Clinical Child & Adolescent Psychologist
690
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1467621425
NPPES
—
Enumeration date
06/04/2015
Last updated
06/04/2015
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