Provider Demographics
NPI:1184914145
Name:CHILDHOOD LANGUAGE CENTER, INC.
Entity type:Organization
Organization Name:CHILDHOOD LANGUAGE CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CUTLIP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-342-7852
Mailing Address - Street 1:1313 QUARRIER ST
Mailing Address - Street 2:STE A
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301
Mailing Address - Country:US
Mailing Address - Phone:304-342-7852
Mailing Address - Fax:
Practice Address - Street 1:1313 QUARRIER ST
Practice Address - Street 2:STE A
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301
Practice Address - Country:US
Practice Address - Phone:304-342-7852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-12
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810022947Medicaid