| Indie Laine Learning Co Llc | |
|
7025 S 42nd Ave Phoenix AZ 85041-3508 | |
| (860) 371-4586 | |
| Not Available |
| Full Name | Indie Laine Learning Co Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 7025 S 42nd Ave, Phoenix, Arizona |
| Authorized Official Name and Position | Jessica T Costa (DIRECTOR OF THERAPY & CONSULTATION) |
| Authorized Official Contact | 8603714586 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Indie Laine Learning Co Llc 7025 S 42nd Ave Phoenix AZ 85041-3508 Ph: (860) 371-4586 | Indie Laine Learning Co Llc 7025 S 42nd Ave Phoenix AZ 85041-3508 Ph: (860) 371-4586 |
| NPI Number | 1073297099 |
|---|---|
| Provider Enumeration Date | 06/12/2023 |
| Last Update Date | 06/12/2023 |
| Certification Date | 06/10/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073297099 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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