Provider Demographics
NPI:1265066385
Name:AUTISM DIAGNOSTIC CENTER
Entity type:Organization
Organization Name:AUTISM DIAGNOSTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COLLEGE ASSISTANT PROFESSOR/SLP
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:575-646-2235
Mailing Address - Street 1:P.O. BOX 30001
Mailing Address - Street 2:MSC 3SPE
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88003
Mailing Address - Country:US
Mailing Address - Phone:575-646-2235
Mailing Address - Fax:575-646-7712
Practice Address - Street 1:1405 INTERNATIONAL MALL
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88003
Practice Address - Country:US
Practice Address - Phone:575-646-2235
Practice Address - Fax:575-646-7712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty