NPIMap

Organization Active NPI

Autism Intervention Milwaukee

  • Community/Behavioral Health Agency
  • Wauwatosa, WI
National Provider Identifier
1821312059
Registry record updated Mar 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
2041-057 Issued in WI
Legal business name
AUTISM INTERVENTION MILWAUKEE
Practice address
2645 N Mayfair Rd
Suite 250
Wauwatosa, WI 53226-1304
Phone
(414) 256-0077
Fax
(414) 256-0090
NPI assigned
Mar 17, 2010
Last updated
Mar 17, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2010

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

Authorized official

Name
Dr. Kathleen Broderick Woody, PSY.D.NPI 1568525673
Title
Clinic Director
Phone
(414) 256-0077

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 2041-057 WI Primary

Addresses

Primary practice location

2645 N Mayfair Rd
Suite 250
Wauwatosa, WI 53226-1304

Mailing address

2645 N Mayfair Rd
Suite 250
Wauwatosa, WI 53226-1304
Phone (414) 256-0077

National Provider Directory

National Provider Directory

Locations

2645 N Mayfair Rd
Ste 250
Wauwatosa, WI 53226
Phone (414) 256-0077

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1268784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268784000000",
    "number": "1821312059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2645 N MAYFAIR RD",
            "address_2": "SUITE 250",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532261304",
            "telephone_number": "414-256-0077",
            "fax_number": "414-256-0090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2645 N MAYFAIR RD",
            "address_2": "SUITE 250",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532261304",
            "telephone_number": "414-256-0077",
            "fax_number": "414-256-0090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTISM INTERVENTION MILWAUKEE",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-17",
        "last_updated": "2010-03-17",
        "status": "A",
        "authorized_official_last_name": "WOODY",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_middle_name": "BRODERICK",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "414-256-0077",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "WI",
            "license": "2041-057",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wauwatosa, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2010; 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.