Healthcare Provider Details

I. General information

NPI: 1598696296
Provider Name (Legal Business Name): ELEVATE ABA AND THERAPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 OLENTANGY XING W
DELAWARE OH
43015-6553
US

IV. Provider business mailing address

300 OLENTANGY XING W
DELAWARE OH
43015-1682
US

V. Phone/Fax

Practice location:
  • Phone: 734-972-9538
  • Fax:
Mailing address:
  • Phone: 734-972-9538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SUBHA VAJJA
Title or Position: OWNER
Credential:
Phone: 734-972-9538