Provider Demographics
NPI:1356644074
Name:CLEVELAND CLINIC CENTER FOR AUTISM
Entity Type:Organization
Organization Name:CLEVELAND CLINIC CENTER FOR AUTISM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CCC/SLP
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEBERDING
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:216-448-6478
Mailing Address - Street 1:2801 MARTIN LUTHER KING DR.
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44104-3815
Mailing Address - Country:US
Mailing Address - Phone:216-448-6478
Mailing Address - Fax:216-448-6445
Practice Address - Street 1:2801 MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44104-3815
Practice Address - Country:US
Practice Address - Phone:216-448-6478
Practice Address - Fax:216-448-6445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP. 9706283XC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283XC2000XHospitalsRehabilitation HospitalChildren