MEDICARE: SUMMIT AUTISM ACADEMY

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	:	1942599477
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT AUTISM ACADEMY

Provider Business Mailing Address
First Line	:	7106 DARCUS CV
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-3721
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10010 ANDERSON MILL RD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78750-2127
Country	:	US
Telephone Number	:	512-258-6017
Fax Number	:

Authorized Official
Title or Position	:	CHAIRPERSON OF THE BOARD
Name	:	TINA SWAFFORD
Credential	:
Telephone Number	:	512-219-9151

Provider Enumeration Date	:	04/05/2011
Last Update Date	:	05/13/2011

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