Healthcare Provider Details

I. General information

NPI: 1235059262
Provider Name (Legal Business Name): MINNEASOTA SPECTRUM CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 SHERMAN ST STE B40F
SAINT PAUL MN
55102-2527
US

IV. Provider business mailing address

360 SHERMAN ST STE B40F
SAINT PAUL MN
55102-2527
US

V. Phone/Fax

Practice location:
  • Phone: 612-601-9769
  • Fax:
Mailing address:
  • Phone: 612-601-9769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: ASHA FARAH
Title or Position: OWNER
Credential:
Phone: 612-601-9769