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General NPI Number Information
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NPI Number | 1447035068
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Entity Type | Organization
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Legal Business Name | DYSLEXIA ACHIEVEMENT CENTER, LLC
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Dates
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Enumeration Date | 08/30/2023
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Last Update Date | 08/30/2023
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Provider Practice Location Address
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Address Line | 910 ELM GROVE RD STE 36
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City | ELM GROVE
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State | WI
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Zip | 53122-2531
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Country | US
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Telephone | 414-949-1051
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Fax |
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Provider Business Mailing Address
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Address Line | 910 ELM GROVE RD STE 36
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City | ELM GROVE
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State | WI
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Zip | 53122-2531
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Country | US
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Telephone | 414-949-1051
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Fax |
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | DR. NICOLE BOYINGTON
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Credential | OTD
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Telephone | 262-262-6065
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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