Provider Demographics
NPI:1538508981
Name:LEARNING DISABILITIES CLINIC
Entity Type:Organization
Organization Name:LEARNING DISABILITIES CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTER
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:248-545-6677
Mailing Address - Street 1:25611 COOLIDGE HWY
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-1306
Mailing Address - Country:US
Mailing Address - Phone:248-545-6677
Mailing Address - Fax:248-545-2152
Practice Address - Street 1:25611 COOLIDGE HWY
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-1306
Practice Address - Country:US
Practice Address - Phone:248-545-6677
Practice Address - Fax:248-545-2152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty