| Lighthouse Autism Center | |
|
5354 Elmore Ave Davenport IA 52807-3859 | |
| (574) 387-4313 | |
| (574) 204-2868 |
| Full Name | Lighthouse Autism Center |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 5354 Elmore Ave, Davenport, Iowa |
| Authorized Official Name and Position | Colin Sheridan (PRESIDENT) |
| Authorized Official Contact | 5742042868 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lighthouse Autism Center 130 Red Coach Dr Mishawaka IN 46545-3144 Ph: (574) 387-4313 | Lighthouse Autism Center 5354 Elmore Ave Davenport IA 52807-3859 Ph: (574) 387-4313 |
| NPI Number | 1194439661 |
|---|---|
| Provider Enumeration Date | 01/10/2023 |
| Last Update Date | 01/18/2023 |
| Certification Date | 01/18/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194439661 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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