Provider Demographics
NPI:1417699455
Name:EARLY CHILDHOOD AUTISM SERVICES LLC
Entity Type:Organization
Organization Name:EARLY CHILDHOOD AUTISM SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENNA
Authorized Official - Middle Name:SCHLAEGEL
Authorized Official - Last Name:WOODRUFF
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:785-425-8091
Mailing Address - Street 1:PO BOX 93
Mailing Address - Street 2:
Mailing Address - City:BASEHOR
Mailing Address - State:KS
Mailing Address - Zip Code:66007-0093
Mailing Address - Country:US
Mailing Address - Phone:785-425-8091
Mailing Address - Fax:
Practice Address - Street 1:12423 DONAHOO RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66109-3140
Practice Address - Country:US
Practice Address - Phone:785-425-8091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty