Indie Laine Learning Co LLC

Primary specialty

Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X

Legal business name

INDIE LAINE LEARNING CO LLC

Practice address

5210 N Central Ave Ste 101
Phoenix, AZ 85012-1489

Phone

(623) 295-1109

NPI assigned

Jun 12, 2023

Last updated

Oct 1, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jessica T Costa, M.S., BCBA, LBANPI 1720674674

Title

Director of Therapy & Consultation

Phone

(860) 371-4586

Specialties & licenses 5

Addresses

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jessica Tavares Costa, MS, BCBA

  • Behavior Analyst
  • Farmington, CT
  • NPI 1720674674
  NPD Authorized official
• Karissa Nesbitt, M.S., CCC-SLP

  • Speech-Language Pathologist
  • Phoenix, AZ
  • NPI 1295212082
  NPD
• Amara Salaam

  • Physical Therapist
  • Phoenix, AZ
  • NPI 1033892989
  NPD (past)
• Denise Terrazas

  • Speech-Language Pathologist
  • Phoenix, AZ
  • NPI 1669006441
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1686528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727740800000",
    "number": "1073297099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7025 S 42ND AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850413508",
            "telephone_number": "860-371-4586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5210 N CENTRAL AVE STE 101",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850121489",
            "telephone_number": "623-295-1109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIE LAINE LEARNING CO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-12",
        "last_updated": "2024-10-01",
        "certification_date": "2024-10-01",
        "status": "A",
        "authorized_official_last_name": "COSTA",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "DIRECTOR OF THERAPY & CONSULTATION",
        "authorized_official_telephone_number": "860-371-4586",
        "authorized_official_credential": "M.S., BCBA, LBA"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Indian Health Services Transportation Management
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• Indigo Crest Wellness LLC
• Indigo Health Clinic, PC
• Individualized Learning Centers LLC (Nova Individualized Learning Center)
• Kelly Andrew Indovina, OD
• Industrial Hand and Physical Therapy Inc

• Developmental Disabilities Clinic/Center in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Developmental Disabilities Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.