Healthcare Provider Details

I. General information

NPI: 1821437161
Provider Name (Legal Business Name): CENTER FOR AUTISM EDUCATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2013
Last Update Date: 06/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 SHERIFF DIERKER CT
O FALLON MO
63366-2468
US

IV. Provider business mailing address

105 SHERIFF DIERKER CT
O FALLON MO
63366-2468
US

V. Phone/Fax

Practice location:
  • Phone: 636-978-7785
  • Fax: 636-978-7885
Mailing address:
  • Phone: 636-978-7785
  • Fax: 636-978-7885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2013012245
License Number StateMO

VIII. Authorized Official

Name: ANGELA HUECKEL
Title or Position: CLINIC DIRECTOR
Credential: BCBA, LBA
Phone: 636-978-7785