Provider Demographics
NPI:1073979225
Name:OLYMPIC PENNINSULA AUTISM CENTER
Entity Type:Organization
Organization Name:OLYMPIC PENNINSULA AUTISM CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEVERDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-337-2222
Mailing Address - Street 1:4008 NW COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-1638
Mailing Address - Country:US
Mailing Address - Phone:732-691-8242
Mailing Address - Fax:
Practice Address - Street 1:3500 NW BUCKLIN HILL RD
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8503
Practice Address - Country:US
Practice Address - Phone:360-337-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services