MEDICARE: EMPOWER AUTISM LLC

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1578318838
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMPOWER AUTISM LLC

Provider Business Mailing Address
First Line	:	3320 N 125TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68164-4285
Country	:	US
Telephone Number	:	402-679-5716
Fax Number	:

Provider Business Practice Location Address
First Line	:	3320 N 125TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68164-4285
Country	:	US
Telephone Number	:	402-679-5716
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MATTHEW CRAIG DENNIS
Credential	:	BCBA
Telephone Number	:	402-679-5716

Provider Enumeration Date	:	04/20/2024
Last Update Date	:	04/20/2024

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Directions to “EMPOWER AUTISM LLC ” Practice Location

Language	Start Address	Practice Location

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