Healthcare Provider Details

I. General information

NPI: 1518333624
Provider Name (Legal Business Name): THERAPEUTIC LEARNING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2015
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 MAIN RD
MILFORD ME
04461-3605
US

IV. Provider business mailing address

PO BOX 249
OLD TOWN ME
04468-0249
US

V. Phone/Fax

Practice location:
  • Phone: 207-356-8211
  • Fax:
Mailing address:
  • Phone: 207-356-8211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH G DYER
Title or Position: CO-OWNER
Credential: CCC-SLP
Phone: 207-356-8211