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General NPI Number Information
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NPI Number | 1245518562
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Entity Type | Organization
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Legal Business Name | POSITIVE LEARNING SOURCE, LLC
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Dates
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Enumeration Date | 08/03/2011
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Last Update Date | 11/30/2012
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Provider Practice Location Address
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Address Line | 4503 N OAKLEY AVE
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City | CHICAGO
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State | IL
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Zip | 60625-2164
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Country | US
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Telephone | 312-718-7711
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Fax | 312-246-4044
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Provider Business Mailing Address
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Address Line | 4503 N OAKLEY AVE
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City | CHICAGO
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State | IL
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Zip | 60625-2164
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Country | US
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Telephone | 312-718-7711
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Fax | 312-246-4044
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Authorized Official
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Title or Position | DEVELOPMENTAL THERAPIST
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Name | CATHERINE BOSSE
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Credential |
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Telephone | 312-718-7711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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