Provider Demographics
NPI:1275001828
Name:RIPPLE EFFECTS AUTISM LEARNING CENTER, LLC
Entity Type:Organization
Organization Name:RIPPLE EFFECTS AUTISM LEARNING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAVALLI
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:859-553-2472
Mailing Address - Street 1:9825 PINE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-7055
Mailing Address - Country:US
Mailing Address - Phone:859-553-2472
Mailing Address - Fax:
Practice Address - Street 1:06321 BLUE STAR MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:SOUTH HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49090-7775
Practice Address - Country:US
Practice Address - Phone:859-553-2472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty