Healthcare Provider Details

I. General information

NPI: 1639955420
Provider Name (Legal Business Name): EMERGENT LEARNING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 E PRIMROSE ST
SPRINGFIELD MO
65807-5254
US

IV. Provider business mailing address

PO BOX 240
NAPERVILLE IL
60566-0240
US

V. Phone/Fax

Practice location:
  • Phone: 417-324-7777
  • Fax: 630-521-5610
Mailing address:
  • Phone: 417-324-7777
  • 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 Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MARK DIXON
Title or Position: BCBA-D
Credential:
Phone: 630-566-0506