Provider Demographics
NPI:1639808819
Name:CREATIVE LEARNING EXPRESSIONS LLC
Entity type:Organization
Organization Name:CREATIVE LEARNING EXPRESSIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:JUANITA
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:419-413-5839
Mailing Address - Street 1:40 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44902-1206
Mailing Address - Country:US
Mailing Address - Phone:419-413-5839
Mailing Address - Fax:
Practice Address - Street 1:40 W 4TH ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44902-1206
Practice Address - Country:US
Practice Address - Phone:419-413-5839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1841780814OtherRBT
OH1083383319OtherRBT
OH1245969492OtherLPN/RBT
OH1821522863OtherSOCIAL WORK