MEDICARE: LIBERTY CENTER FOR LANGUAGE AND LEARNING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1093039208
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERTY CENTER FOR LANGUAGE AND LEARNING, LLC

Provider Business Mailing Address
First Line	:	6791 E ROCK CANYON PL
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85750-6071
Country	:	US
Telephone Number	:	529-991-0877
Fax Number	:

Provider Business Practice Location Address
First Line	:	6791 E ROCK CANYON PL
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85750-6071
Country	:	US
Telephone Number	:	529-991-0877
Fax Number	:

Authorized Official
Title or Position	:	CO OWNER, DIRECTOR
Name	:	MRS. STEPHANIE MARIE GENTEMAN
Credential	:
Telephone Number	:	520-991-0877

Provider Enumeration Date	:	03/16/2010
Last Update Date	:	03/16/2010

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Directions to “LIBERTY CENTER FOR LANGUAGE AND LEARNING, LLC ” Practice Location

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