MEDICARE: HEALING AUTISM SPECTRUM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1508621913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING AUTISM SPECTRUM

Provider Business Mailing Address
First Line	:	3400 1ST ST N STE 303
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56303-1927
Country	:	US
Telephone Number	:	612-597-8712
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 1ST ST N STE 303
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56303-1927
Country	:	US
Telephone Number	:	612-597-8712
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HAWO YUSSUF
Credential	:
Telephone Number	:	612-597-8712

Provider Enumeration Date	:	02/15/2024
Last Update Date	:	02/19/2024

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