Healthcare Provider Details

I. General information

NPI: 1477098507
Provider Name (Legal Business Name): ATTENTION & LEARNING SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2016
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5775 WAYZATA BLVD, SUITE 700
ST LOUIS PARK MN
55416
US

IV. Provider business mailing address

5775 WAYZATA BLVD, SUITE 700
ST LOUIS PARK MN
55416
US

V. Phone/Fax

Practice location:
  • Phone: 612-799-6263
  • Fax: 888-827-5513
Mailing address:
  • Phone: 612-799-6263
  • Fax: 888-827-5513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberLP 1450
License Number StateMN

VIII. Authorized Official

Name: ALLEN STOCK
Title or Position: OWNER
Credential: MA, LP
Phone: 612-799-6263