Provider Demographics
NPI:1578305686
Name:LEARNING GROVE ABA LLC
Entity type:Organization
Organization Name:LEARNING GROVE ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:EMIL
Authorized Official - Last Name:THEISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-581-5426
Mailing Address - Street 1:702 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MOSINEE
Mailing Address - State:WI
Mailing Address - Zip Code:54455-1311
Mailing Address - Country:US
Mailing Address - Phone:715-581-5426
Mailing Address - Fax:
Practice Address - Street 1:1204 WESTON AVE
Practice Address - Street 2:
Practice Address - City:ROTHSCHILD
Practice Address - State:WI
Practice Address - Zip Code:54474-1160
Practice Address - Country:US
Practice Address - Phone:715-581-5426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-10
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty