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General NPI Number Information
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NPI Number | 1144551664
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Entity Type | Organization
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Legal Business Name | CHILDHOOD AUTISM THERAPIES LLC
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Dates
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Enumeration Date | 01/22/2010
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Last Update Date | 01/22/2010
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Provider Practice Location Address
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Address Line | N1563 COUNTY ROAD H
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City | PALMYRA
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State | WI
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Zip | 53156-9738
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Country | US
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Telephone | 262-370-5527
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Fax | 262-495-8689
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Provider Business Mailing Address
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Address Line | N1563 COUNTY ROAD H
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City | PALMYRA
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State | WI
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Zip | 53156-9738
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Country | US
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Telephone | 262-370-5527
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Fax | 262-495-8689
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. COLLEEN A RYAN
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Credential | PHD
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Telephone | 262-370-7744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 2387-57
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 2387-57
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License Number State | WI
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