MEDICARE: KEYSTONE AUTISM SOLUTIONS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1902408297
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEYSTONE AUTISM SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	3507 W CAPILANO DR
Second Line	:
City	:	WEST LAFAYETTE
State	:	IN
Zip	:	47906-8879
Country	:	US
Telephone Number	:	765-430-8285
Fax Number	:

Provider Business Practice Location Address
First Line	:	933 S STATE ROAD 57 STE B
Second Line	:
City	:	WASHINGTON
State	:	IN
Zip	:	47501-4374
Country	:	US
Telephone Number	:	765-430-8285
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. MARY RAUB
Credential	:
Telephone Number	:	765-430-8285

Provider Enumeration Date	:	11/11/2020
Last Update Date	:	11/11/2020

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Directions to “KEYSTONE AUTISM SOLUTIONS LLC ” Practice Location

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