MEDICARE: ABA CENTER OF MINNESOTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1336971548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABA CENTER OF MINNESOTA

Provider Business Mailing Address
First Line	:	1509 88TH AVE N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55444-1358
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1509 88TH AVE N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55444-1358
Country	:	US
Telephone Number	:	612-207-3736
Fax Number	:	612-500-4100

Authorized Official
Title or Position	:	OWNER
Name	:	AMIR MUSSA
Credential	:
Telephone Number	:	612-207-3736

Provider Enumeration Date	:	08/16/2024
Last Update Date	:	08/23/2024

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Directions to “ABA CENTER OF MINNESOTA ” Practice Location

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