Healthcare Provider Details

I. General information

NPI: 1447035068
Provider Name (Legal Business Name): DYSLEXIA ACHIEVEMENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 ELM GROVE RD STE 36
ELM GROVE WI
53122-2531
US

IV. Provider business mailing address

910 ELM GROVE RD STE 36
ELM GROVE WI
53122-2531
US

V. Phone/Fax

Practice location:
  • Phone: 414-949-1051
  • Fax:
Mailing address:
  • Phone: 414-949-1051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
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
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. NICOLE BOYINGTON
Title or Position: OWNER/MEMBER
Credential: OTD
Phone: 262-262-6065