# MOON AUTISM CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225789001
- **Authorized official:** SUZANNE JUZWIK BCBA (OWNER)
- **Authorized official phone:** (310) 488-2814

## Contact information

- **Practice address:** 609 S MEADOWBROOK LN, WAUNAKEE, WI 53597-2829
- **Practice address phone:** (720) 441-8288
- **Mailing address:** 609 S MEADOWBROOK LN, WAUNAKEE, WI 53597-2829

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103K00000X | Behavior Analyst | — | NULL | Yes |
| 103K00000X | Behavior Analyst | — | — | Yes |

## Other

- **Enumeration date:** 01/13/2022
- **Last updated:** 01/13/2022