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General NPI Number Information
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NPI Number | 1477414225
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Entity Type | Organization
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Legal Business Name | AUTISM CLINIC CORP
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Dates
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Enumeration Date | 11/20/2025
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 15349 BLACK FRIARS RD
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City | ORLAND PARK
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State | IL
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Zip | 60462-3877
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Country | US
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Telephone | 708-745-2884
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Fax |
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Provider Business Mailing Address
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Address Line | 15349 BLACK FRIARS RD
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City | ORLAND PARK
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State | IL
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Zip | 60462-3877
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Country | US
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Telephone | 708-745-2884
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Fax |
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Authorized Official
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Title or Position | RPT
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Name | RONZA SAMAD
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Credential |
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Telephone | 708-745-2884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101200000X
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Taxonomy Name | Drama Therapist
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License Number |
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License Number State |
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