INTERDISCIPLINARY COMMUNITY AUTISM NETWORK, INC


Address: 409 E Cook Rd, Suite 100, Fort Wayne, IN 46825-3600
Phone: 2604989933

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).

Provider Overview

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

Taxonomy

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 Provider/Organization Names

Other Name Type Code
ICAN Doing Business As Name - Organization

Office Location

Street Address 409 E COOK RD
SUITE 100
City FORT WAYNE
State IN
Zip Code 46825-3600

Providers in the same location

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

Providers in the same zip code

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 Information

Taxonomy Code 251S00000X
Grouping Agencies
Classification Community/Behavioral Health

Taxonomy Definition

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]

Providers in the same taxonomy and city

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

Competitor

Search similar providers

City FORT WAYNE
Zip Code 46825

Improve Information

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Dataset Information

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.

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