Organization
INTERDISCIPLINARY COMMUNITY AUTISM NETWORK, INC
Active
Other names
ICAN
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARLA JEAN SOUDER PSYD, HSPP (PRESIDENT/COO)
(260) 498-9933
Entity
Organization
Contact information
Practice address
409 E COOK RD, SUITE 100, FORT WAYNE, IN 46825-3600
(260) 498-9933
Mailing address
2599 COUNTY ROAD 72, AUBURN, IN 46706-9624
(260) 498-9933
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
103TC0700X
Clinical Psychologist
20042225A
IN
103TS0200X
School Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
171M00000X
Case Manager/Care Coordinator
—
—
222Q00000X
Developmental Therapist
—
—
225100000X
Physical Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
11/21/2013
Last updated
11/21/2013
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