Provider Demographics
NPI:1447776042
Name:MOSAIC LEARNING SYSTEMS, INC.
Entity Type:Organization
Organization Name:MOSAIC LEARNING SYSTEMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:SANDRA
Authorized Official - Last Name:MACLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA-D, LBA
Authorized Official - Phone:801-574-4150
Mailing Address - Street 1:1915 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98363-1605
Mailing Address - Country:US
Mailing Address - Phone:801-574-4150
Mailing Address - Fax:
Practice Address - Street 1:1915 W 5TH ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98363-1605
Practice Address - Country:US
Practice Address - Phone:801-574-4150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABA-60761536103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty