Healthcare Provider Details

I. General information

NPI: 1477608644
Provider Name (Legal Business Name): LACLEDE EARLY EDUCATION PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22864 PERIMETER LN.
LEBANON MO
65536-1023
US

IV. Provider business mailing address

P. O. BOX 1023 22864 PERIMETER LN.
LEBANON MS
65536
US

V. Phone/Fax

Practice location:
  • Phone: 417-532-6528
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE EMBRY
Title or Position: DIRECTOR
Credential:
Phone: 417-532-6528