Provider Demographics
NPI:1750664561
Name:FORT WAYNE AUTISM CENTER INC
Entity Type:Organization
Organization Name:FORT WAYNE AUTISM CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BIERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-245-1455
Mailing Address - Street 1:172 W CARMEL DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-2526
Mailing Address - Country:US
Mailing Address - Phone:317-815-5501
Mailing Address - Fax:
Practice Address - Street 1:2817 E DUPONT RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1668
Practice Address - Country:US
Practice Address - Phone:260-245-1455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty