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General NPI Number Information
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NPI Number | 1952613069
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Entity Type | Organization
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Legal Business Name | AUTISM TREATMENT FOR CHILDREN, LLC
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Dates
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Enumeration Date | 07/06/2010
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Last Update Date | 09/24/2018
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Provider Practice Location Address
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Address Line | 2665 S MOORLAND RD STE 100
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City | NEW BERLIN
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State | WI
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Zip | 53151-2900
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Country | US
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Telephone | 414-475-1896
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Fax | 414-988-9764
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Provider Business Mailing Address
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Address Line | 2665 S MOORLAND RD STE 100
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City | NEW BERLIN
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State | WI
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Zip | 53151-2900
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Country | US
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Telephone | 414-475-1896
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Fax | 414-988-9764
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. JILL C RUDMAN
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Credential | PH.D., BCBA
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Telephone | 414-475-1896
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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 | 2172057
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License Number State | WI
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