MEDICARE: SYVENS LEARNING ACADEMY

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	261QF0050X	Non-Surgical Family Planning Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649947789
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYVENS LEARNING ACADEMY

Provider Business Mailing Address
First Line	:	5063 N 19TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-5762
Country	:	US
Telephone Number	:	414-745-0471
Fax Number	:

Provider Business Practice Location Address
First Line	:	5063 N 19TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-5762
Country	:	US
Telephone Number	:	414-745-0471
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JAZMINE MCCOLLUM
Credential	:
Telephone Number	:	414-745-0471

Provider Enumeration Date	:	08/26/2021
Last Update Date	:	08/26/2021

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