Provider Demographics
NPI:1619314192
Name:ABC DYSLEXIA CENTER, LLC
Entity Type:Organization
Organization Name:ABC DYSLEXIA CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALETA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-854-9377
Mailing Address - Street 1:1819 CENTRAL AVE S
Mailing Address - Street 2:122
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-7501
Mailing Address - Country:US
Mailing Address - Phone:253-854-9377
Mailing Address - Fax:
Practice Address - Street 1:1819 CENTRAL AVE S
Practice Address - Street 2:122
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-7501
Practice Address - Country:US
Practice Address - Phone:206-824-4456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental HealthGroup - Multi-Specialty
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Multi-Specialty