Healthcare Provider Details

I. General information

NPI: 1316457542
Provider Name (Legal Business Name): RISE THROUGH LEARNING CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2017
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3159 N SEMINARY AVE APT 307
CHICAGO IL
60657
US

IV. Provider business mailing address

3159 N SEMINARY AVE APT 307
CHICAGO IL
60657-3359
US

V. Phone/Fax

Practice location:
  • Phone: 248-821-9152
  • Fax:
Mailing address:
  • Phone: 248-821-9152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1826202
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN SUDNIK
Title or Position: FOUNDER, SCHOOL PSYCHOLOGIST
Credential:
Phone: 248-821-9152