# IMPACT AUTISM SC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548083769
- **Authorized official:** FADUMO ADEM (OPERATIONAL MANGER)
- **Authorized official phone:** (619) 576-6887

## Contact information

- **Practice address:** 6160 SUMMIT DR N STE 200, BROOKLYN CENTER, MN 55430-2181
- **Practice address phone:** (619) 576-6887
- **Mailing address:** 6160 SUMMIT DR N, SUITE 200 OFFICE \#219, BROOKLYN CENTER, MN 55430
- **Mailing address phone:** (619) 576-6887

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 252Y00000X | Early Intervention Provider Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 11/05/2024
- **Last updated:** 11/05/2024