Basic Information
Provider Information
NPI: 1629418934
EntityType: 2
ReplacementNPI:  
OrganizationName: KIDS UNLIMITED LEARNING ACADEMY
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Mailing Information
Address1: 1901 PINE VALLEY LN
Address2:  
City: JONESBORO
State: AR
PostalCode: 724048435
CountryCode: US
TelephoneNumber: 8707616680
FaxNumber: 5012467919
Practice Location
Address1: 2792 S 2ND ST
Address2: SUITES B & C
City: CABOT
State: AR
PostalCode: 720237020
CountryCode: US
TelephoneNumber: 8707616680
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Other Information
ProviderEnumerationDate: 07/01/2013
LastUpdateDate: 08/14/2014
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AuthorizedOfficialLastName: DECKER
AuthorizedOfficialFirstName: SHELLY
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AuthorizedOfficialTitleorPosition: CEO
AuthorizedOfficialTelephone: 8707616680
IsSoleProprietor:  
IsOrganizationSubpart: N
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AuthorizedOfficialCredential: MCD, CCC-SLP
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X  N193200000X MULTI-SPECIALTY GROUPRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 
235Z00000X  N193200000X MULTI-SPECIALTY GROUPSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist 
225X00000X  Y193200000X MULTI-SPECIALTY GROUPRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

ID Information
IDTypeStateIssuerDescription
19993474205AR MEDICAID


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