Provider Demographics
NPI:1689723595
Name:CHILDRENS LEARNING CONNECTION, LLC
Entity Type:Organization
Organization Name:CHILDRENS LEARNING CONNECTION, LLC
Other - Org Name:CHILDREN'S LEARNING CONNECTION, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHEIF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:
Authorized Official - Last Name:WINTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-241-6780
Mailing Address - Street 1:505 N. BRAND BLVD
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203
Mailing Address - Country:US
Mailing Address - Phone:855-295-3276
Mailing Address - Fax:818-241-6853
Practice Address - Street 1:5312 BOLSA AVE.
Practice Address - Street 2:STE. # 105
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649
Practice Address - Country:US
Practice Address - Phone:818-241-6780
Practice Address - Fax:818-241-6853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABCBA 1-07-3352103K00000X
CABCBA 1-09-5316103K00000X
CA1-09-5375103K00000X
CABCBA 1-03-1209103K00000X
CAPT 362832251P0200X
CAPT 374802251P0200X
CAOT 8264225XP0200X
CAOT 11533225XP0200X
CASP12005235Z00000X
CASP 11693235Z00000X
CASP 15824235Z00000X
CASP 15812235Z00000X
CASP 14005235Z00000X
CASP 10842235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty