Provider Demographics
NPI:1386426278
Name:MINNESOTA CHILDREN'S AUTISM CENTER
Entity type:Organization
Organization Name:MINNESOTA CHILDREN'S AUTISM CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NAWAL
Authorized Official - Middle Name:ABDI
Authorized Official - Last Name:MURSAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-850-5277
Mailing Address - Street 1:1901 W 80 1/2 ST UNIT 308
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-5107
Mailing Address - Country:US
Mailing Address - Phone:360-850-5277
Mailing Address - Fax:
Practice Address - Street 1:1901 W 80 1/2 ST UNIT 308
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-5107
Practice Address - Country:US
Practice Address - Phone:360-850-5277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency