| Wisconsin Early Autism Project | |
|
1210 Fourier Drive Suite #100 Madison WI 53717-1969 | |
| (608) 662-9327 | |
| (608) 662-9041 |
| Full Name | Wisconsin Early Autism Project |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 1210 Fourier Drive, Madison, Wisconsin |
| Authorized Official Name and Position | Kim Lauree Schutt-chardon (DIRECTOR OF BILLING) |
| Authorized Official Contact | 6086629327 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wisconsin Early Autism Project 1210 Fourier Drive Suite #100 Madison WI 53717-1969 Ph: (608) 662-9327 | Wisconsin Early Autism Project 1210 Fourier Drive Suite #100 Madison WI 53717-1969 Ph: (608) 662-9327 |
| NPI Number | 1043406978 |
|---|---|
| Provider Enumeration Date | 09/25/2007 |
| Last Update Date | 11/17/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043406978 | NPI | - | NPPES |
| 42223400 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | HFS 61.91 (Wisconsin) | Primary |
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