Healthcare Provider Details

I. General information

NPI: 1700276748
Provider Name (Legal Business Name): STAR ACADEMY OF TOLEDO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2015
Last Update Date: 01/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5025 GLENDALE AVE DOOR #3
TOLEDO OH
43614
US

IV. Provider business mailing address

5025 GLENDALE AVE DOOR #3
TOLEDO OH
43614
US

V. Phone/Fax

Practice location:
  • Phone: 419-720-6330
  • Fax: 419-720-7372
Mailing address:
  • Phone: 419-720-6330
  • Fax: 419-720-7372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MS. JULIETA R DINKINS
Title or Position: HEAD OF SCHOOL
Credential: M.ED
Phone: 419-720-6330