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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