SOUTHEAST MISSOURI STATE UNIVERSITY AUTISM CENTER (NPI# 1699020503) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699020503 |
| Entity Type | Organization |
| Organization Name | SOUTHEAST MISSOURI STATE UNIVERSITY AUTISM CENTER |
| Practice Address |
611 N Fountain St Cape Girardeau MO 63701-7244 |
| Mailing Address |
1 University Plz Mailstop 9450 Cape Girardeau MO 63701-4710 |
| Practice Telephone | 5739864985 |
| Practice Fax Number | 5739864994 |
| Mailing Telephone | 5739864985 |
| Mailing Fax Number | 5739864994 |
| Enumeration Date | 2012-07-17 |
| Last Update Date | 2012-07-17 |
| Authorized Official Name | CONNIE L HEBERT (DIRECTOR) |
| Authorized Official Telephone | 5739864985 |
| Authorized Official Credential | MS ED. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 1316261621 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316261621 | Southeast Missouri State University Autism Center | Community/Behavioral Health | 611 N. Fountain St., Cape Girardeau, MO 63701-7244 | 2010-03-16 |
| Street Address |
611 N FOUNTAIN ST |
| City | CAPE GIRARDEAU |
| State | MO |
| Zip Code | 63701-7244 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619155421 | Jessica Lynn Harrison | Behavioral Analyst | 611 N Fountain St, Cape Girardeau, MO 63701-7244 | 2008-02-04 |
| 1194341958 | Rachel Francis | Behavioral Analyst | 611 N Fountain St, Cape Girardeau, MO 63701-7244 | 2020-06-17 |
| 1891316493 | Ashten Ozbun | Behavioral Analyst | 611 N Fountain St, Cape Girardeau, MO 63701-7244 | 2020-05-05 |
| 1326689183 | Erica Danielle Welter | Speech-Language Pathologist | 611 N Fountain St, Cape Girardeau, MO 63701-7244 | 2019-10-03 |
| 1518422088 | Allison Jeanette Bruner | Behavioral Analyst | 611 N Fountain St, Cape Girardeau, MO 63701-7244 | 2019-02-08 |
| 1326596172 | Jennifer Partridge | Speech-Language Pathologist | 611 N Fountain St, Cape Girardeau, MO 63701-7244 | 2016-09-21 |
| 1255755252 | Nicole Danielle Maxfield | Behavioral Analyst | 611 N Fountain St, Cape Girardeau, MO 63701-7244 | 2014-02-11 |
| 1639415136 | Jamie Suzanne Brazer | Behavioral Analyst | 611 N Fountain St, Cape Girardeau, MO 63701-7244 | 2013-01-02 |
| 1821396789 | Laura Leanne Hopper | Behavioral Analyst | 611 N Fountain St, Thompson Center, Cape Girardeau, MO 63701-7244 | 2011-03-02 |
| 1528365251 | Michelle Renee Patrick | Psychologist | 611 N Fountain St, Cape Girardeau, MO 63701-7244 | 2011-02-15 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336748110 | Westbrook Dialysis, LLC | Clinic/Center | 140 West Drive, Cape Girardeau, MO 63701 | 2020-10-22 |
| 1972079580 | Savannah Laine Menard | Behavior Technician | 20 S. Sprigg St, Cape Girardeau, MO 63701 | 2018-10-22 |
| 1932690377 | Broadway Specialty, LLC | Pharmacy | 706 Broadway St, Cape Girardeau, MO 63701 | 2018-05-22 |
| 1356864649 | Terri L. Mccord | Pharmacist | 4170 Connor Dr, Cape Girardeau, MO 63701 | 2017-07-19 |
| 1013459312 | Christina Cossou | Nurse Practitioner | 2116 Megan Dr Ste 102, Cape Girardeau, MO 63701 | 2016-11-17 |
| 1124573365 | Ashley Sullivan | Massage Therapist | 3041 Melrose Ave, Cape Girardeau, MO 63701 | 2016-08-17 |
| 1225432172 | Axpm - Merkley, LLC | Dentist | 2116 Megan Dr., Suite 101, Cape Girardeau, MO 63701 | 2014-10-21 |
| 1639573397 | Marian Perez Hurt | Physical Therapist | 2001 N. Kingshighway, Fountainbleau Lodge, Cape Girardeau, MO 63701 | 2014-10-09 |
| 1891194213 | Deanna Abner | Case Manager/Care Coordinator | 20 South Sprigg, Cape Girardeau, MO 63701 | 2014-08-21 |
| 1831506880 | Kwadwo O Britwum | Behavioral Analyst | Morningstar Behavioral Associates, 338 W. Broadway Suite 301, Cape Girardeau, MO 63701 | 2014-07-22 |
| Find all providers in zip 63701 | ||||
| Taxonomy Code | 320900000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
| A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730567751 | Preferred Family Healthcare | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3105 Independence St, Suite B, Cape Girardeau, MO 63703-5042 | 2015-05-11 |
| 1902233711 | Blue Sky Cimmunity Services | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2354 Rusmar St, Cape Girardeau, MO 63703-7616 | 2013-10-11 |
| 1669997979 | Aspirations for Independent Living LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1858 Broadway St, Cape Girardeau, MO 63701-4553 | 2017-08-08 |
| 1033511761 | Semo Alliance for Disability Independence | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1913 Rusmar St, Cape Girardeau, MO 63703-7623 | 2014-09-25 |
| 1295014470 | Southeast Missouri State University | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2100 Themis St Ste 103c, Cape Girardeau, MO 63701-5124 | 2011-08-05 |
| 1699826750 | Regency Management Inc Bollinger | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1330 Southern Expy, Cape Girardeau, MO 63703-7706 | 2007-01-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609475516 | Brandi Janelle Hickman | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 8706 Newton Ave Apt 4101, Kansas City, MO 64138-5461 | 2020-10-21 |
| 1154935112 | Overcomers Counseling Center Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 17101 East 203rd St, Peculiar, MO 64078 | 2020-09-06 |
| 1386265965 | Candace Palmer | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2405 Bowe Ln, Jefferson City, MO 65109-9116 | 2020-05-05 |
| 1902426596 | Matt Ferguson | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 4480 Bradley Dr, Joplin, MO 64804-5503 | 2020-04-23 |
| 1689206211 | Insight Industry LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2501 Ne Prairie Falcon Dr, Blue Springs, MO 64014-1958 | 2020-02-11 |
| 1598306904 | Hearo Technologies LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 405 N Jefferson Ave Ste 1063, Springfield, MO 65806-1110 | 2019-10-07 |
| 1437790219 | Darin Roark | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2628 Se Kimbrough Ln, Lees Summit, MO 64063-1082 | 2019-10-03 |
| 1942851399 | Wyatt's Dream Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 205 State Highway Aa, Sikeston, MO 63801-5303 | 2019-09-26 |
| 1043871908 | Cura Personalis, (care for The Whole Person), LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 11650 Bobwhite Road, Carthage, MO 64836 | 2019-06-21 |
| 1043870181 | Rebuild Contracting LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1783 Possum Hollow Dr, Camdenton, MO 65020-6709 | 2019-06-20 |
| Find all providers with the same taxonomy | ||||
| City | CAPE GIRARDEAU |
| Zip Code | 63701 |
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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.