MEDICARE: AUTISM AWARENESS ASSOCIATION INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	302F00000X	Exclusive Provider Organization	302F00000X	KS

General Provider Information

NPI Number	:	1013188945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUTISM AWARENESS ASSOCIATION INC.

Provider Business Mailing Address
First Line	:	4031 E HARRY ST
Second Line	:	P O BOX 780898
City	:	WICHITA
State	:	KS
Zip	:	67218-3724
Country	:	US
Telephone Number	:	316-771-7335
Fax Number	:	316-771-7201

Provider Business Practice Location Address
First Line	:	4031 E HARRY ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67218-3724
Country	:	US
Telephone Number	:	316-771-7335
Fax Number	:	316-771-7201

Authorized Official
Title or Position	:	LICENSED CLINICAL PROFESSIONAL COUN
Name	:	MS. RONALD HESSMAN
Credential	:	LCPC
Telephone Number	:	620-663-4802

Provider Enumeration Date	:	03/19/2008
Last Update Date	:	03/19/2008

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