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General NPI Number Information
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NPI Number | 1356145619
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Entity Type | Organization
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Legal Business Name | GREAT LAKES LEARNING ACADEMY
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Dates
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Enumeration Date | 04/03/2025
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | 2875 EYDE PKWY #200
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City | EAST LANSING
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State | MI
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Zip | 48823
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Country | US
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Telephone | 517-381-5062
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Fax | 517-451-3025
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Provider Business Mailing Address
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Address Line | 2875 EYDE PKWY #200
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City | EAST LANSING
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State | MI
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Zip | 48823
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Country | US
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Telephone | 517-381-5062
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Fax | 517-451-3025
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Authorized Official
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Title or Position | SPECIAL EDUCATION MANAGER
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Name | MELANIE MILLER
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Credential |
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Telephone | 810-553-6986
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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 |
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