Organization
INTERDISCIPLINARY COMMUNITY AUTISM NETWORK, INC
Active
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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