Organization
AUTIS-IMAGINATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA A. GRANT CCC-SLP (OWNER/SLP)
(816) 213-6173
Entity
Organization
Contact information
Practice address
1500 NW MOCK AVE # C, BLUE SPRINGS, MO 64015-3095
(816) 213-6173
(816) 229-6997
Mailing address
1500 NW MOCK AVE # C, BLUE SPRINGS, MO 64015-3095
(816) 213-6173
(816) 229-6997
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
856253109
—
MO
Enumeration date
01/11/2009
Last updated
01/11/2009
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