=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538570718
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LITTLE TIGER LEARNING COMPANY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2014
-----------------------------------------------------
Last Update Date | 05/09/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | S78W18425 LIONS PARK DR APT 1
-----------------------------------------------------
City | MUSKEGO
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53150-8703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-477-1143
-----------------------------------------------------
Fax | 414-751-1911
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 778
-----------------------------------------------------
City | MUSKEGO
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53150-0778
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-477-1143
-----------------------------------------------------
Fax | 414-751-1911
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BOARD CERTIFIED BEHAVIOR ANALYST
-----------------------------------------------------
Name | MS. ELAINE I LEE
-----------------------------------------------------
Credential | BCBA
-----------------------------------------------------
Telephone | 414-477-1143
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 67-140
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------