Healthcare Provider Details

I. General information

NPI: 1891455309
Provider Name (Legal Business Name): AUTISM AND BRAIN INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2021
Last Update Date: 07/23/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9480 S EASTERN AVE STE 273
LAS VEGAS NV
89123-8000
US

IV. Provider business mailing address

10300 W CHARLESTON BLVD STE 549
LAS VEGAS NV
89135-1037
US

V. Phone/Fax

Practice location:
  • Phone: 702-463-5460
  • Fax: 888-316-4826
Mailing address:
  • Phone: 702-463-5460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code261QA3000X
TaxonomyAugmentative Communication Clinic/Center
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATHERINE HANTA WALLISCH
Title or Position: CEO
Credential: M.S. CCC-SLP
Phone: 702-355-9862