Provider Demographics
NPI:1902093834
Name:MINNESOTA EARLY AUTISM PROJECT
Entity type:Organization
Organization Name:MINNESOTA EARLY AUTISM PROJECT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:LAUREE
Authorized Official - Last Name:SCHUTT-CHARDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-288-9040
Mailing Address - Street 1:6402 ODANA RD
Mailing Address - Street 2:ATTN: WEAP
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1123
Mailing Address - Country:US
Mailing Address - Phone:608-288-9040
Mailing Address - Fax:608-288-9042
Practice Address - Street 1:7236 FORESTVIEW LN N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-5656
Practice Address - Country:US
Practice Address - Phone:763-493-7935
Practice Address - Fax:763-493-7936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty