| Chattanooga Autism Center | |
|
3097 Broad St Chattanooga TN 37408-3089 | |
| (423) 260-1115 | |
| (423) 752-5299 |
| Full Name | Chattanooga Autism Center |
|---|---|
| Speciality | Social Worker |
| Location | 3097 Broad St, Chattanooga, Tennessee |
| Authorized Official Name and Position | Karen Lynn Weigle (PRESIDENT) |
| Authorized Official Contact | 4232601115 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chattanooga Autism Center 4445 Wellesley Dr Ooltewah TN 37363-4887 Ph: (423) 260-1115 | Chattanooga Autism Center 3097 Broad St Chattanooga TN 37408-3089 Ph: (423) 260-1115 |
| NPI Number | 1134486855 |
|---|---|
| Provider Enumeration Date | 04/19/2012 |
| Last Update Date | 04/19/2012 |
| Medicare PECOS PAC ID | 2365695236 |
|---|---|
| Medicare Enrollment ID | O20130102000231 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134486855 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 0000004479 (Tennessee) | Primary |
| Provider Name | Mari A Benson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275521049 PECOS PAC ID: 4688637333 Enrollment ID: I20041104000592 |
| Provider Name | Karen L Weigle |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1821246497 PECOS PAC ID: 9830250067 Enrollment ID: I20081206000121 |
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