Healthcare Provider Details

I. General information

NPI: 1851422745
Provider Name (Legal Business Name): THE CHILDREN'S LEARNING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 09/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 W BIG TRAIL DR
JACKSON WY
83001-9296
US

IV. Provider business mailing address

PO BOX 4100
JACKSON WY
83001-4100
US

V. Phone/Fax

Practice location:
  • Phone: 307-733-3791
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVEY HOUGH
Title or Position: SPECIAL EDUCATION DIRECTOR
Credential:
Phone: 307-733-3791