Provider Demographics
NPI:1578726493
Name:ACACIA EDUCATIONAL THERAPEUTIC & DIAGNOSTIC LEARNING CENTER LLP
Entity Type:Organization
Organization Name:ACACIA EDUCATIONAL THERAPEUTIC & DIAGNOSTIC LEARNING CENTER LLP
Other - Org Name:ACACIA LEARNING CENTER LLP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPEECH/LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:MCGINNIS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:216-280-9347
Mailing Address - Street 1:11811 SHAKER BLVD
Mailing Address - Street 2:SUITE #305
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44121-1927
Mailing Address - Country:US
Mailing Address - Phone:216-280-9347
Mailing Address - Fax:
Practice Address - Street 1:11811 SHAKER BLVD
Practice Address - Street 2:SUITE #305
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44121-1927
Practice Address - Country:US
Practice Address - Phone:216-280-9347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1273225X00000X
OH3667235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty