Healthcare Provider Details

I. General information

NPI: 1144935891
Provider Name (Legal Business Name): SPECTRUMWORKS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 81ST AVE NE
SPRING LAKE PARK MN
55432-2116
US

IV. Provider business mailing address

10101 BREN RD E UNIT 107
MINNETONKA MN
55343-0029
US

V. Phone/Fax

Practice location:
  • Phone: 612-886-5794
  • Fax:
Mailing address:
  • Phone:
  • 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 Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: ABDIRAHMAN ABDINOOR
Title or Position: DIRECTOR
Credential:
Phone: 612-886-5794