# LAKE AUTISM CENTER INC

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

## Provider details

- **NPI number:** 1639927239
- **Authorized official:** AMINA MOHAMUD MOHAMED (OWNER)
- **Authorized official phone:** (952) 200-3664

## Contact information

- **Practice address:** 1330 LAGOON AVE STE 425, MINNEAPOLIS, MN 55408-2885
- **Practice address phone:** (952) 200-3684
- **Mailing address:** 1330 LAGOON AVE STE 425, MINNEAPOLIS, MN 55408-2885
- **Mailing address phone:** (952) 200-3684

## Taxonomy

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

## Other

- **Enumeration date:** 05/08/2024
- **Last updated:** 05/08/2024