NPIMap

Organization Active NPI

Creative Life Skills Development

  • Developmental Disabilities Clinic/Center
  • Surprise, AZ
National Provider Identifier
1184703670
Registry record updated Sep 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X
Legal business name
CREATIVE LIFE SKILLS DEVELOPMENT
Practice address
15508 W Bell Rd
Suite 101-261
Surprise, AZ 85374-2432
Phone
(602) 441-5975
Fax
(602) 485-8859
NPI assigned
Nov 3, 2006
Last updated
Sep 7, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2011

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

Authorized official

Name
Mrs. Lisa Lyn Herrmann, M.S OTR/LNPI 1114130754
Title
Owner
Phone
(602) 441-5975

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental Disabilities Clinic/Center 261QD1600X NU Primary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X 2762 AZ
Pediatric Physical Therapist 2251P0200X NU
Pediatric Occupational Therapist 225XP0200X NU
Speech-Language Pathologist 235Z00000X NU

Addresses

Primary practice location

15508 W Bell Rd
Suite 101-261
Surprise, AZ 85374-2432

Mailing address

15508 W Bell Rd
Suite 101-261
Surprise, AZ 85374-2432
Phone (602) 441-5975

National Provider Directory

National Provider Directory

Locations

15508 W Bell Rd
Ste 101261
Surprise, AZ 85374
Phone (602) 441-5975

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315353600000",
    "number": "1184703670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15508 W BELL RD",
            "address_2": "SUITE 101-261",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853742432",
            "telephone_number": "602-441-5975",
            "fax_number": "602-485-8859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15508 W BELL RD",
            "address_2": "SUITE 101-261",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853742432",
            "telephone_number": "602-441-5975",
            "fax_number": "602-485-8859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREATIVE LIFE SKILLS DEVELOPMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-03",
        "last_updated": "2011-09-07",
        "status": "A",
        "authorized_official_last_name": "HERRMANN",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "LYN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "602-441-5975",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "M.S OTR/L"
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "AZ",
            "license": "2762",
            "primary": false
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Surprise, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2011; 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.