Healthcare Provider Details

I. General information

NPI: 1043406978
Provider Name (Legal Business Name): AUTISM SPECTRUM THERAPIES OF DELAWARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 FOURIER DRIVE SUITE #100
MADISON WI
53717-1969
US

IV. Provider business mailing address

1242 FOURIER DR STE 100
MADISON WI
53717-2096
US

V. Phone/Fax

Practice location:
  • Phone: 608-662-9327
  • Fax: 608-662-9041
Mailing address:
  • Phone: 608-662-9327
  • Fax: 608-662-9041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberHFS 61.91
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MELISSA WHALEN
Title or Position: DIRECTOR, CONTRACTS & CREDENTIALING
Credential:
Phone: 508-363-0200