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NPI Code Detail

MEDICARE: CHILDREN'S AUTISM CENTER, INC

MEDICARE: CHILDREN'S AUTISM CENTER, 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
1225X00000XOccupational Therapist
2235Z00000XSpeech-Language Pathologist
3261QD1600XDevelopmental Disabilities Clinic/Center

General Provider Information

NPI Number : 1215105663
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHILDREN'S AUTISM CENTER, INC
Provider Business Mailing Address
First Line : 5601 COVENTRY LN
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-7145
Country : US
Telephone Number : 260-459-6040
Fax Number : 260-459-6010
Provider Business Practice Location Address
First Line : 5601 COVENTRY LN
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-7145
Country : US
Telephone Number : 260-459-6040
Fax Number : 260-459-6010
Authorized Official
Title or Position : BOARD PRESIDENT
Name : MS. JILL DIANE FORTE
Credential : M.S.
Telephone Number : 260-459-6040
Provider Enumeration Date : 02/19/2008
Last Update Date : 05/29/2025

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Directions to “CHILDREN'S AUTISM CENTER, INC ” Practice Location

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