Provider Demographics
NPI:1720138589
Name:PEDIATRIC AUTISM & COMMUNICATION THERAPY INSTITUTE, INC.
Entity Type:Organization
Organization Name:PEDIATRIC AUTISM & COMMUNICATION THERAPY INSTITUTE, INC.
Other - Org Name:PACT INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER & DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:KIMBERLY
Authorized Official - Last Name:WEISE-BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:952-224-0707
Mailing Address - Street 1:1014 MAINSTREET
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-7534
Mailing Address - Country:US
Mailing Address - Phone:952-224-0707
Mailing Address - Fax:952-224-1612
Practice Address - Street 1:1014 MAINSTREET
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-7534
Practice Address - Country:US
Practice Address - Phone:952-224-0707
Practice Address - Fax:952-224-1612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN368261700Medicaid
MN013H3PAMedicare UPIN
MN109404Medicare UPIN
MN46055Medicare UPIN
MN386L0PAMedicare UPIN
MN39026Medicare UPIN