| Autism Services Of Michiana Llc | |
|
4201 Cottage Ave Mishawaka IN 46544-3848 | |
| (574) 383-0107 | |
| Not Available |
| Full Name | Autism Services Of Michiana Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 4201 Cottage Ave, Mishawaka, Indiana |
| Authorized Official Name and Position | Sherry R Forzley (BOARD CERTIFIED BEHAVIOR ANALYST) |
| Authorized Official Contact | 5743830107 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Autism Services Of Michiana Llc 4201 Cottage Ave Mishawaka IN 46544-3848 Ph: (574) 383-0107 | Autism Services Of Michiana Llc 4201 Cottage Ave Mishawaka IN 46544-3848 Ph: (574) 383-0107 |
| NPI Number | 1982059069 |
|---|---|
| Provider Enumeration Date | 04/26/2016 |
| Last Update Date | 04/26/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982059069 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | 1-16-21690 (Colorado) | Primary |
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