Healthcare Provider Details

I. General information

NPI: 1932821477
Provider Name (Legal Business Name): AUTISM INSTITUTE OF MINNESOTA LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1973 SLOAN PL STE 100
MAPLEWOOD MN
55117-2085
US

IV. Provider business mailing address

1973 SLOAN PL STE 100
MAPLEWOOD MN
55117-2085
US

V. Phone/Fax

Practice location:
  • Phone: 651-797-4821
  • Fax: 651-369-9887
Mailing address:
  • Phone: 651-797-4821
  • Fax: 651-369-9887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. KHADAR WARDERE
Title or Position: DIRECTOR
Credential:
Phone: 651-797-4821