Organization
AUTISM SERVICES OF MICHIANA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHERRY R FORZLEY MA, BCBA (BOARD CERTIFIED BEHAVIOR ANALYST)
(574) 383-0107
Entity
Organization
Contact information
Practice address
4201 COTTAGE AVE, MISHAWAKA, IN 46544-3848
(574) 383-0107
Mailing address
4201 COTTAGE AVE, MISHAWAKA, IN 46544-3848
(574) 383-0107
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-16-21690
CO
Other
Enumeration date
04/26/2016
Last updated
04/26/2016
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