Provider Demographics
NPI:1144551664
Name:CHILDHOOD AUTISM THERAPIES LLC
Entity type:Organization
Organization Name:CHILDHOOD AUTISM THERAPIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:262-370-7744
Mailing Address - Street 1:N1563 COUNTY ROAD H
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:WI
Mailing Address - Zip Code:53156-9738
Mailing Address - Country:US
Mailing Address - Phone:262-370-5527
Mailing Address - Fax:262-495-8689
Practice Address - Street 1:N1563 COUNTY ROAD H
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:WI
Practice Address - Zip Code:53156-9738
Practice Address - Country:US
Practice Address - Phone:262-370-5527
Practice Address - Fax:262-495-8689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2387-57103TC2200X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty