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General NPI Number Information
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NPI Number | 1447776042
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Entity Type | Organization
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Legal Business Name | MOSAIC LEARNING SYSTEMS, INC.
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Dates
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Enumeration Date | 08/16/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1915 W 5TH ST
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City | PORT ANGELES
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State | WA
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Zip | 98363-1605
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Country | US
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Telephone | 801-574-4150
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Fax |
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Provider Business Mailing Address
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Address Line | 1915 W 5TH ST
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City | PORT ANGELES
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State | WA
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Zip | 98363-1605
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Country | US
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Telephone | 801-574-4150
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. KATHERINE SANDRA MACLEOD
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Credential | BCBA-D, LBA
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Telephone | 801-574-4150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BA-60761536
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License Number State | WA
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