Clubhouse Autism and Developmental Center LLC

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Legal business name

CLUBHOUSE AUTISM AND DEVELOPMENTAL CENTER LLC

Practice address

1001 College Ave
Jackson, AL 36545-2402

Phone

(251) 769-0021

NPI assigned

Jul 20, 2021

Last updated

Jul 20, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Savanna Williams, SLPNPI 1497264154

Title

Owner

Phone

(251) 751-1687

Specialties & licenses 3

Addresses

Locations

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.

• Savanna Williams, SLP

  • Speech-Language Pathologist
  • Chatom, AL
  • NPI 1497264154
  Authorized official Same address or phone
• Jenna Elmore, OTR/L

  • Occupational Therapist
  • Chatom, AL
  • NPI 1740892892
  NPD

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

{
    "created_epoch": "1626739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626739200000",
    "number": "1912570797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 759",
            "city": "CHATOM",
            "state": "AL",
            "postal_code": "365180759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 COLLEGE AVE",
            "city": "JACKSON",
            "state": "AL",
            "postal_code": "365452402",
            "telephone_number": "251-769-0021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLUBHOUSE AUTISM AND DEVELOPMENTAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-20",
        "last_updated": "2021-07-20",
        "certification_date": "2021-07-19",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "SAVANNA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "251-751-1687",
        "authorized_official_credential": "SLP"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Johnnie Brooks Burnett, PT,MS,OSC
• City of Jackson Health Care Authority
• City of Jackson Healthcare Authority (Family Medical of Clinic of Jackson)
• City of Jackson Healthcare Authority (Jackson Medical Center Home Health)
• City of Jackson Healthcare Authority
• Jessie Louise Criswell, CRNP
• Sidney S Crosby, MD
• Crystal's Helping Hand's
• Jennifer Tolbert Dowling, CRNP
• Kimberly P Duff

• Speech-Language Pathologist in Jackson, AL
• Providers in Jackson, AL by specialty
• Speech-Language Pathologist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 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.