| Success on the Spectrum | |
|
1303 S Longmore Ste 2 Mesa AZ 85202-9607 | |
| (801) 635-6208 | |
| Not Available |
| Full Name | Success on the Spectrum |
|---|---|
| Speciality | Behavior Analyst |
| Location | 1303 S Longmore Ste 2, Mesa, Arizona |
| Authorized Official Name and Position | Ted Holmgren (OWNER, GENERAL MANAGER) |
| Authorized Official Contact | 8016356208 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Success on the Spectrum 5018 E Hannibal St Mesa AZ 85205-6879 Ph: (801) 635-6208 | Success on the Spectrum 1303 S Longmore Ste 2 Mesa AZ 85202-9607 Ph: (801) 635-6208 |
| NPI Number | 1194435149 |
|---|---|
| Provider Enumeration Date | 11/30/2022 |
| Last Update Date | 11/30/2022 |
| Certification Date | 11/30/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194435149 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | () | Primary |
| 261QH0700X | Clinic/center - Hearing And Speech | () | Secondary |
| 261QX0100X | Clinic/center - Occupational Medicine | () | Secondary |
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