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General NPI Number Information
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NPI Number | 1265066385
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Entity Type | Organization
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Legal Business Name | AUTISM DIAGNOSTIC CENTER
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Dates
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Enumeration Date | 02/27/2020
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Last Update Date | 02/27/2020
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Provider Practice Location Address
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Address Line | 1405 INTERNATIONAL MALL
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City | LAS CRUCES
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State | NM
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Zip | 88003
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Country | US
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Telephone | 575-646-2235
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Fax | 575-646-7712
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Provider Business Mailing Address
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Address Line | P.O. BOX 30001 MSC 3SPE
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City | LAS CRUCES
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State | NM
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Zip | 88003
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Country | US
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Telephone | 575-646-2235
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Fax | 575-646-7712
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Authorized Official
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Title or Position | COLLEGE ASSISTANT PROFESSOR/SLP
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Name | DENISE M. SANCHEZ
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Credential | M.A., CCC-SLP
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Telephone | 575-646-2235
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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