INTERDISCIPLINARY COMMUNITY AUTISM NETWORK, INC (NPI# 1336579754) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1336579754 |
Entity Type | Organization |
Organization Name | INTERDISCIPLINARY COMMUNITY AUTISM NETWORK, INC |
Other Organization Name | ICAN |
Practice Address |
409 E Cook Rd Suite 100 Fort Wayne IN 46825-3600 |
Mailing Address |
2599 County Road 72 Auburn IN 46706-9624 |
Practice Telephone | 2604989933 |
Mailing Telephone | 2604989933 |
Enumeration Date | 2013-11-21 |
Last Update Date | 2013-11-21 |
Authorized Official Name | DR. MARLA JEAN SOUDER (PRESIDENT/COO) |
Authorized Official Telephone | 2604989933 |
Authorized Official Credential | PSYD, HSPP |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 101Y00000X | Counselor | Behavioral Health & Social Service Providers | ||
N | 103TC0700X |
Psychologist Specialization: Clinical |
20042225A | IN | Behavioral Health & Social Service Providers |
N | 103TS0200X |
Psychologist Specialization: School |
Behavioral Health & Social Service Providers | ||
N | 1041C0700X |
Social Worker Specialization: Clinical |
Behavioral Health & Social Service Providers | ||
N | 171M00000X | Case Manager/Care Coordinator | Other Service Providers | ||
N | 222Q00000X | Developmental Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
N | 225100000X | Physical Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
N | 235Z00000X | Speech-Language Pathologist | Speech, Language and Hearing Service Providers | ||
Y | 251S00000X | Community/Behavioral Health | Agencies |
Other Name | Type Code |
---|---|
ICAN | Doing Business As Name - Organization |
Street Address |
409 E COOK RD SUITE 100 |
City | FORT WAYNE |
State | IN |
Zip Code | 46825-3600 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1376974378 | Life Stages Therapy Center, Inc | Counselor | 409 E Cook Rd, Suite 100, Fort Wayne, IN 46825-3600 | 2013-12-02 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1336772078 | Bradley Murphy | Occupational Therapist | 2626 St Joe Center Ed, Fort Wayne, IN 46825 | 2020-02-21 |
1144851015 | Sabryna Roman | Developmental Therapist | 2626 St Joe Center Rd, Fort Wayne, IN 46825 | 2020-01-30 |
1205474103 | Ashleigh Miller | Developmental Therapist | 2626 St. Joe Center Rd, Fort Wayne, IN 46825 | 2019-12-11 |
1962055152 | Carehalo Ohio LLC | General Practice | 2510 Dupont Circle Dr., Suite 201, Fort Wayne, IN 46825 | 2019-07-17 |
1306318175 | Logan Alan Williams | Nurse Anesthetist, Certified Registered | 10315 Dawsons Creek Blvd Ste B, Fort Wayne, IN 46825 | 2018-12-18 |
1326582925 | Mark F Stoner LLC | Dentist | 9830 Auburn Rd Suite 102, Fort Wayne, IN 46825 | 2016-12-15 |
1336695782 | Nadine Rene' Handy | Nurse Practitioner | 3978 New Vision Dr., Fort Wayne, IN 46825 | 2016-08-26 |
1558815712 | Nathan Paul Miller | Physical Therapist | 10006 Auburn Park Dr, Fort Wayne, IN 46825 | 2016-08-05 |
1013366905 | Brianna Abbott | Physician Assistant | 1234 E Dupont Rd Ste 7, Fort Wayne, IN 46825 | 2016-06-10 |
1003276643 | Seiss, LLC | Psychologist | 9910 Dupont Circle Drive, Suite 140, Fort Wayne, IN 46825 | 2016-02-24 |
Find all providers in zip 46825 |
Taxonomy Code | 251S00000X |
Grouping | Agencies |
Classification | Community/Behavioral Health |
A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1568084416 | Renaissance Counseling Center,llc | Community/Behavioral Health | 1210 Guthrie St, Fort Wayne, IN 46802 | 2020-05-14 |
1174163844 | Neighborhood Mentoring Academy Inc. | Community/Behavioral Health | 916 E Hawthorne St, Fort Wayne, IN 46806-3144 | 2020-01-10 |
1336604883 | Christman Consulting, LLC | Community/Behavioral Health | 1623 Fairhill Rd, Fort Wayne, IN 46808-3026 | 2019-02-08 |
1093200214 | Sky Point Social Services | Community/Behavioral Health | 9434 Lima Rd Ste C, Fort Wayne, IN 46818-8934 | 2018-06-29 |
1689194615 | A.i.d. Social Services | Community/Behavioral Health | 10323 Dawsons Creek Blvd Ste A, Fort Wayne, IN 46825-1910 | 2017-06-21 |
1598212326 | Infinite Journey, LLC | Community/Behavioral Health | 9910 Dupont Circle Dr E, Ste 140, Fort Wayne, IN 46825-1617 | 2016-09-09 |
1346601366 | Fort Wayne Clubhouse, Inc | Community/Behavioral Health | 3327 Lake Ave, Fort Wayne, IN 46805-5529 | 2016-03-18 |
1871906917 | Springhealth Integrated Care, Inc. | Community/Behavioral Health | 4410 Executive Blvd, Fort Wayne, IN 46808-1135 | 2014-06-06 |
1154747632 | Gret Machlan LLC | Community/Behavioral Health | 2200 Lake Ave Ste 125, Fort Wayne, IN 46805-5358 | 2014-03-08 |
1386905677 | Comprehensive Mental Health Services and Consultin | Community/Behavioral Health | 1517 Kentucky Ave, Fort Wayne, IN 46805-5003 | 2012-06-03 |
Find all providers in FORT WAYNE |
City | FORT WAYNE |
Zip Code | 46825 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.