Provider Demographics
NPI:1245518562
Name:POSITIVE LEARNING SOURCE, LLC
Entity type:Organization
Organization Name:POSITIVE LEARNING SOURCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEVELOPMENTAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-718-7711
Mailing Address - Street 1:4503 N OAKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2164
Mailing Address - Country:US
Mailing Address - Phone:312-718-7711
Mailing Address - Fax:312-246-4044
Practice Address - Street 1:4503 N OAKLEY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2164
Practice Address - Country:US
Practice Address - Phone:312-718-7711
Practice Address - Fax:312-246-4044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-03
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency