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General NPI Number Information
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NPI Number | 1942198734
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Entity Type | Organization
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Legal Business Name | MIND SPARKS L. L. C.
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Dates
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Enumeration Date | 06/27/2025
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | 19344 136TH AVE N
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City | ROGERS
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State | MN
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Zip | 55374-4848
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Country | US
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Telephone | 612-281-6238
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Fax |
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Provider Business Mailing Address
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Address Line | 19344 136TH AVE N
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City | ROGERS
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State | MN
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Zip | 55374-4848
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Country | US
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Telephone | 612-281-6238
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED AGENT
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Name | MUNA MOHAMED JEDAL
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Credential |
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Telephone | 612-281-6238
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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