Healthcare Provider Details

I. General information

NPI: 1083036859
Provider Name (Legal Business Name): KNOXVILLE CENTER FOR AUTISM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2014
Last Update Date: 01/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9051 EXECUTIVE PARK DR SUITE 200
KNOXVILLE TN
37923-4606
US

IV. Provider business mailing address

9051 EXECUTIVE PARK DR SUITE 200
KNOXVILLE TN
37923-4606
US

V. Phone/Fax

Practice location:
  • Phone: 865-200-5127
  • Fax: 865-200-5127
Mailing address:
  • Phone: 865-200-5127
  • Fax: 865-200-5127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5189
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: SARA L GILBERT
Title or Position: PRESIDENT/DIRECTOR
Credential: M.S. BCBA
Phone: 865-200-5127