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General NPI Number Information
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NPI Number | 1336915370
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Entity Type | Organization
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Legal Business Name | AUTISM SOCIETY OF SOUTHEASTERN WISCONSIN
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Dates
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Enumeration Date | 11/30/2023
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Last Update Date | 12/11/2023
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Provider Practice Location Address
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Address Line | 3720 N 124TH ST STE O
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City | WAUWATOSA
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State | WI
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Zip | 53222-2100
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Country | US
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Telephone | 414-988-1260
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Fax |
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Provider Business Mailing Address
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Address Line | 3720 N 124TH ST STE O
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City | WAUWATOSA
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State | WI
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Zip | 53222-2100
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Country | US
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Telephone | 414-988-1260
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | STEPHANIE WAGNER
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Credential |
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Telephone | 414-988-1261
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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