Provider Demographics
NPI:1669725834
Name:INTEGRATED INTERVENTION FOR CHILDREN WITH AUTISM
Entity type:Organization
Organization Name:INTEGRATED INTERVENTION FOR CHILDREN WITH AUTISM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:CHRISTINA
Authorized Official - Last Name:HAUGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:408-621-4008
Mailing Address - Street 1:911 BERN CT
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-1242
Mailing Address - Country:US
Mailing Address - Phone:408-621-4008
Mailing Address - Fax:
Practice Address - Street 1:911 BERN CT
Practice Address - Street 2:SUITE 130
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-1242
Practice Address - Country:US
Practice Address - Phone:408-621-4008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-24
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP9875235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty