Provider Demographics
NPI:1215261045
Name:BLACKWELL & ROSCOE AUTISM SPECTRUM INTERVENTION PARTNERS, INC.
Entity type:Organization
Organization Name:BLACKWELL & ROSCOE AUTISM SPECTRUM INTERVENTION PARTNERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:800-531-4191
Mailing Address - Street 1:112 HOLLY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-4639
Mailing Address - Country:US
Mailing Address - Phone:314-749-7768
Mailing Address - Fax:800-560-2140
Practice Address - Street 1:112 HOLLY DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-4639
Practice Address - Country:US
Practice Address - Phone:314-749-7768
Practice Address - Fax:800-560-2140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-26
Last Update Date:2009-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty