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General NPI Number Information
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NPI Number | 1265707301
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Entity Type | Organization
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Legal Business Name | CONCORDIA CREATIVE LEARNING ACADEMY
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Dates
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Enumeration Date | 03/21/2012
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Last Update Date | 03/21/2012
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Provider Practice Location Address
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Address Line | 930 GERANIUM AVE E
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City | SAINT PAUL
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State | MN
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Zip | 55106-2610
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Country | US
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Telephone | 651-793-6624
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Fax |
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Provider Business Mailing Address
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Address Line | 930 GERANIUM AVE E
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City | SAINT PAUL
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State | MN
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Zip | 55106-2610
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SPECIAL EDUCATION COORDINATOR
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Name | APRIL REED
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Credential |
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Telephone | 651-793-6624
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State | MN
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