Provider Demographics
NPI:1407073505
Name:WIEBUSCH & NICHOLSON CENTER FOR AUTISM, INC.
Entity Type:Organization
Organization Name:WIEBUSCH & NICHOLSON CENTER FOR AUTISM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:WIEBUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:262-347-0701
Mailing Address - Street 1:N27W23953 PAUL RD
Mailing Address - Street 2:STE. 206
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-6242
Mailing Address - Country:US
Mailing Address - Phone:262-347-0701
Mailing Address - Fax:262-347-0705
Practice Address - Street 1:N27W23953 PAUL RD
Practice Address - Street 2:STE. 206
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-6242
Practice Address - Country:US
Practice Address - Phone:262-347-0701
Practice Address - Fax:262-347-0705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health