Organization
SOUTHEAST MISSOURI STATE UNIVERSITY AUTISM CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CONNIE L HEBERT MS ED. (DIRECTOR)
(573) 986-4985
Entity
Organization
Contact information
Practice address
611 N FOUNTAIN ST, CAPE GIRARDEAU, MO 63701-7244
(573) 986-4985
(573) 986-4994
Mailing address
1 UNIVERSITY PLZ, MAILSTOP 9450, CAPE GIRARDEAU, MO 63701-4710
(573) 986-4985
(573) 986-4994
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316261621
—
MO
Enumeration date
07/17/2012
Last updated
07/17/2012
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