Healthcare Provider Details

I. General information

NPI: 1184128571
Provider Name (Legal Business Name): LEARNING INSTITUTE FOR FUNCTIONAL EDUCATION (L.I.F.E.)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 N CARPENTER RD STE C19
MODESTO CA
95351-1156
US

IV. Provider business mailing address

1620 N CARPENTER RD STE C19
MODESTO CA
95351-1156
US

V. Phone/Fax

Practice location:
  • Phone: 209-900-3722
  • Fax: 209-859-9005
Mailing address:
  • Phone: 209-900-3722
  • Fax: 209-859-9005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MISS TERRA DAWN OEHLER
Title or Position: CEO
Credential: BCBA
Phone: 209-900-3722