Healthcare Provider Details

I. General information

NPI: 1104411297
Provider Name (Legal Business Name): DKD FOR AUTISM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2021
Last Update Date: 03/02/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N WILLIAM E CRAWFORD AVE
FATE TX
75087
US

IV. Provider business mailing address

410 HICKORY LN
FATE TX
75087-6709
US

V. Phone/Fax

Practice location:
  • Phone: 469-338-5442
  • Fax: 214-602-2729
Mailing address:
  • Phone: 972-722-3892
  • Fax: 214-602-2729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: KARRI SHOJAEI-SCOTT
Title or Position: CLINICAL DIRECTOR /OWNER
Credential:
Phone: 972-722-3892