NPIMap

Organization Active NPI

Wolff & Phan Autism Center, LLC

Doing business as Wolff PAC

  • Behavior Analyst
  • Fairlawn, OH
National Provider Identifier
1750979233
Registry record updated Aug 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Legal business name
WOLFF & PHAN AUTISM CENTER, LLC
Doing business as
Wolff PAC
Practice address
3505 Embassy Pkwy Ste 100
Fairlawn, OH 44333-8403
Phone
(330) 271-6107
Fax
(330) 706-4705
NPI assigned
Jan 9, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kim Phan Wolff, BCBA, COBANPI 1376871194
Title
Ceo & Founder
Phone
(330) 271-6107

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193400000X SINGLE SPECIALTY GROUP 103K00000X Primary

Addresses

Primary practice location

3505 Embassy Pkwy Ste 100
Fairlawn, OH 44333-8403

Mailing address

3505 Embassy Pkwy Ste 100
Fairlawn, OH 44333-8403
Phone (330) 271-6107

Other identifiers 1

IdentifierTypeStateIssuer
0433777MedicaidOH

Other names 1

  • Wolff PAC Doing business as

National Provider Directory

National Provider Directory

Locations

3505 Embassy Pkwy
Ste 100
Fairlawn, OH 44333
Phone (330) 271-6107

Practitioners & affiliated clinicians

Practitioners 28

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 28

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1610150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629244800000",
    "number": "1750979233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3505 EMBASSY PKWY STE 100",
            "city": "FAIRLAWN",
            "state": "OH",
            "postal_code": "443338403",
            "telephone_number": "330-271-6107",
            "fax_number": "330-706-4705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3505 EMBASSY PKWY STE 100",
            "city": "FAIRLAWN",
            "state": "OH",
            "postal_code": "443338403",
            "telephone_number": "330-271-6107",
            "fax_number": "330-706-4705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOLFF & PHAN AUTISM CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-09",
        "last_updated": "2021-08-18",
        "certification_date": "2021-08-18",
        "status": "A",
        "authorized_official_last_name": "WOLFF",
        "authorized_official_first_name": "KIM",
        "authorized_official_middle_name": "PHAN",
        "authorized_official_title_or_position": "CEO & FOUNDER",
        "authorized_official_telephone_number": "330-271-6107",
        "authorized_official_credential": "BCBA, COBA"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0433777",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wolff PAC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fairlawn, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.