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General NPI Number Information
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NPI Number | 1306620323
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Entity Type | Organization
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Legal Business Name | EDUCATES
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Dates
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Enumeration Date | 08/21/2023
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 1317 W TOWNE SQUARE RD
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City | MEQUON
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State | WI
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Zip | 53092-5017
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Country | US
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Telephone | 414-687-4856
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Fax |
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Provider Business Mailing Address
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Address Line | 10451 N STRATFORD PL
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City | MEQUON
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State | WI
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Zip | 53092-5554
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Country | US
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Telephone | 414-687-4856
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. LISA SARAH GENDELMAN
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Credential |
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Telephone | 414-687-4856
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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