Provider Demographics
NPI:1689295958
Name:EARLY AUTISM SERVICES
Entity type:Organization
Organization Name:EARLY AUTISM SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WESSELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-914-0611
Mailing Address - Street 1:306 N KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60526-1870
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7049 PERSHING AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130-4319
Practice Address - Country:US
Practice Address - Phone:312-914-0611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health