Provider Demographics
NPI:1083036859
Name:KNOXVILLE CENTER FOR AUTISM, INC.
Entity Type:Organization
Organization Name:KNOXVILLE CENTER FOR AUTISM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MS BCBA
Authorized Official - Phone:865-200-5127
Mailing Address - Street 1:9051 EXECUTIVE PARK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4606
Mailing Address - Country:US
Mailing Address - Phone:865-200-5127
Mailing Address - Fax:865-200-5127
Practice Address - Street 1:9051 EXECUTIVE PARK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4606
Practice Address - Country:US
Practice Address - Phone:865-200-5127
Practice Address - Fax:865-200-5127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
TN5189235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5442213Medicaid