Provider Demographics
NPI:1487947172
Name:THE AUTISM PROGRAM
Entity type:Organization
Organization Name:THE AUTISM PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CENTER DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCPC
Authorized Official - Phone:217-525-8332
Mailing Address - Street 1:5220 S 6TH STREET RD
Mailing Address - Street 2:SUITE 1700
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-5735
Mailing Address - Country:US
Mailing Address - Phone:217-525-8332
Mailing Address - Fax:217-789-1420
Practice Address - Street 1:5220 S 6TH STREET RD
Practice Address - Street 2:SUITE 1700
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-5735
Practice Address - Country:US
Practice Address - Phone:217-525-8332
Practice Address - Fax:217-789-1420
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE HOPE SCHOOL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006213101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty