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NPI Code Detail

MEDICARE: KIDS UNLIMITED LEARNING ACADEMY OF SPRINGDALE

MEDICARE: KIDS UNLIMITED LEARNING ACADEMY OF SPRINGDALE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QR0400XRehabilitation Clinic/Center

General Provider Information

NPI Number : 1417512369
Entity Type Code : Organization
Provider Name (Legal Business Name) : KIDS UNLIMITED LEARNING ACADEMY OF SPRINGDALE
Provider Business Mailing Address
First Line : 1900 STILLWATER DR
Second Line :
City : JONESBORO
State : AR
Zip : 72404-9119
Country : US
Telephone Number : 870-932-3600
Fax Number : 870-932-3611
Provider Business Practice Location Address
First Line : 1268 ELECTRIC AVE
Second Line :
City : SPRINGDALE
State : AR
Zip : 72764-7498
Country : US
Telephone Number : 870-932-3600
Fax Number :
Authorized Official
Title or Position : CEO
Name : MRS. SHELLY KELLER
Credential : MCD, CCC-SLP
Telephone Number : 870-761-6680
Provider Enumeration Date : 05/07/2019
Last Update Date : 05/07/2019

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1861057713 — KIDS UNLIMITED LEARNING ACADEMY OF SPRINGDALE
Practice Location Address:
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SPRINGDALE, AR
72764-7498
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Practice Fax:

Directions to “KIDS UNLIMITED LEARNING ACADEMY OF SPRINGDALE ” Practice Location

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