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General NPI Number Information
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NPI Number | 1831951136
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Entity Type | Organization
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Legal Business Name | SPECIAL MINDS ASD SERVICES
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Dates
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Enumeration Date | 01/23/2024
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Last Update Date | 02/01/2024
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Provider Practice Location Address
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Address Line | 3188 124TH LN NE UNIT G
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City | BLAINE
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State | MN
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Zip | 55449-6160
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Country | US
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Telephone | 612-987-3257
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Fax |
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Provider Business Mailing Address
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Address Line | 3188 124TH LN NE UNIT G
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City | BLAINE
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State | MN
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Zip | 55449-6160
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Country | US
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Telephone | 612-987-3257
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | AYAN USMAN
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Credential |
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Telephone | 612-987-3257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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