Organization
CHILDHOOD AUTISM THERAPIES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. COLLEEN A RYAN PHD (DIRECTOR)
(262) 370-7744
Entity
Organization
Contact information
Practice address
N1563 COUNTY ROAD H, PALMYRA, WI 53156-9738
(262) 370-5527
(262) 495-8689
Mailing address
N1563 COUNTY ROAD H, PALMYRA, WI 53156-9738
(262) 370-5527
(262) 495-8689
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
2387-57
WI
103TC2200X
Clinical Child & Adolescent Psychologist
2387-57
WI
Other
Enumeration date
01/22/2010
Last updated
01/22/2010
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