Provider Demographics
NPI:1679327506
Name:AUTISM FORENSICS
Entity type:Organization
Organization Name:AUTISM FORENSICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:KUTZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-667-3098
Mailing Address - Street 1:4940 WARD RD
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-2124
Mailing Address - Country:US
Mailing Address - Phone:571-451-4380
Mailing Address - Fax:901-250-8631
Practice Address - Street 1:4940 WARD RD
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-2124
Practice Address - Country:US
Practice Address - Phone:571-451-4380
Practice Address - Fax:901-250-8631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty