Provider Demographics
NPI:1093394124
Name:AUTISM CLINIC CORP
Entity Type:Organization
Organization Name:AUTISM CLINIC CORP
Other - Org Name:AUTISM CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINSTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHADEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KASSAR
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:630-631-9623
Mailing Address - Street 1:7255 GEORGETOWN CMNS
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-3001
Mailing Address - Country:US
Mailing Address - Phone:708-378-4550
Mailing Address - Fax:630-920-0552
Practice Address - Street 1:7255 GEORGETOWN CMNS
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-3001
Practice Address - Country:US
Practice Address - Phone:708-378-4550
Practice Address - Fax:630-920-0552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-06
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty