Organization
ASD IMPACT INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERRICKA BORDER (OWNER)
(262) 880-5864
Entity
Organization
Contact information
Practice address
6601 WASHINGTON AVE, RACINE, WI 53406-3923
(262) 880-5864
Mailing address
1017 STRATFORD CT, RACINE, WI 53406-7001
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
128554121
WI
Other
Enumeration date
07/11/2014
Last updated
07/11/2014
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