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General NPI Number Information
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NPI Number | 1538519947
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Entity Type | Organization
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Legal Business Name | KALAMAZOO AUTISM CENTER
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Dates
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Enumeration Date | 06/16/2016
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Last Update Date | 06/16/2016
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Provider Practice Location Address
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Address Line | 4200 S WESTNEDGE AVE
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City | KALAMAZOO
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State | MI
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Zip | 49008-3208
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Country | US
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Telephone | 269-599-5769
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Fax |
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Provider Business Mailing Address
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Address Line | 4200 S WESTNEDGE AVE
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City | KALAMAZOO
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State | MI
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Zip | 49008-3208
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. KELLY KOHLER
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Credential | BCBA-D, PHD
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Telephone | 269-599-5769
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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