Healthcare Provider Details

I. General information

NPI: 1104066463
Provider Name (Legal Business Name): AUTISM SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2009
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5924 ANAHEIM AVE NE STE B
ALBUQUERQUE NM
87113-1879
US

IV. Provider business mailing address

5924 ANAHEIM AVE NE STE B
ALBUQUERQUE NM
87113-1879
US

V. Phone/Fax

Practice location:
  • Phone: 505-720-7537
  • Fax: 505-922-4917
Mailing address:
  • Phone: 505-720-7537
  • Fax: 505-922-4917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. JESSICA A DONALDSON
Title or Position: CEO
Credential: PHD., M.S., CCC-SLP
Phone: 505-720-7537