Provider Demographics
NPI:1609412667
Name:INSPIRING MINDS - PEDIATRIC AUTISM CONSULTATION AND THERAPY, LLC
Entity Type:Organization
Organization Name:INSPIRING MINDS - PEDIATRIC AUTISM CONSULTATION AND THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHASIDY
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:WILKE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:715-966-5216
Mailing Address - Street 1:2223 TERRACE VIEW DR APT 3A
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-5486
Mailing Address - Country:US
Mailing Address - Phone:715-966-5216
Mailing Address - Fax:
Practice Address - Street 1:2223 TERRACE VIEW DR APT 3A
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-5486
Practice Address - Country:US
Practice Address - Phone:715-966-5216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty