Healthcare Provider Details

I. General information

NPI: 1023941697
Provider Name (Legal Business Name): JUST KIDS AUTISM CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5221 VIKING DR
BLOOMINGTON MN
55435-5317
US

IV. Provider business mailing address

5221 VIKING DR
BLOOMINGTON MN
55435-5317
US

V. Phone/Fax

Practice location:
  • Phone: 651-502-2945
  • Fax: 612-230-5364
Mailing address:
  • Phone: 651-502-2945
  • Fax: 612-230-5364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: SALENA LOLITA MAY SAGE
Title or Position: LEVEL 2
Credential:
Phone: 651-502-2945