Healthcare Provider Details

I. General information

NPI: 1972135606
Provider Name (Legal Business Name): EMERGENT LEARNING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2020
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11780 BORMAN DR STE 400
SAINT LOUIS MO
63146-4135
US

IV. Provider business mailing address

PO BOX 240
NAPERVILLE IL
60566-0240
US

V. Phone/Fax

Practice location:
  • Phone: 314-949-1222
  • Fax: 630-521-5610
Mailing address:
  • Phone: 630-566-0506
  • Fax: 630-521-5610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MARK DIXON
Title or Position: PRESIDENT
Credential:
Phone: 314-275-0506