| Organization Name: | CHILDRENS LEARNING CONNECTION, LLC |
| NPI Number: | 1689723595 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARK RUSSELL (C.F.O.) |
| Mailing Address: | 18350 Mount Langley Street Suite 105 Fountain Valley |
| State: | CA US |
| Postal Code: | 92708 |
| Phone Number: | 8552953276 |
| Fax Number: | 8182416853 |
| NPI Enumeration Date: | 01/09/2007 |
| NPI Last Update Date: | 09/22/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SP 15824 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |