Healthcare Provider Details

I. General information

NPI: 1881070944
Provider Name (Legal Business Name): HUMAN DEVELOPMENT LEARNING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2015
Last Update Date: 07/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6833 W FOND DU LAC AVE
MILWAUKEE WI
53218-3900
US

IV. Provider business mailing address

6833 W FOND DU LAC AVE
MILWAUKEE WI
53218-3900
US

V. Phone/Fax

Practice location:
  • Phone: 414-699-4636
  • Fax: 414-449-9912
Mailing address:
  • Phone: 414-699-4636
  • Fax: 414-449-9912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: KALEATHA NABORS
Title or Position: DIRECTOR
Credential:
Phone: 414-699-4636