Provider Demographics
NPI:1376371419
Name:UNIQUE NEURODIVERSITY ACADEMY LLC
Entity type:Organization
Organization Name:UNIQUE NEURODIVERSITY ACADEMY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENUNIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:310-658-1714
Mailing Address - Street 1:317 W HILLCREST BLVD APT 2
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-2633
Mailing Address - Country:US
Mailing Address - Phone:310-658-1714
Mailing Address - Fax:
Practice Address - Street 1:317 W HILLCREST BLVD APT 2
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-2633
Practice Address - Country:US
Practice Address - Phone:310-658-1714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services