Organization
IMPACT AUTISM SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FADUMO ADEM (OPERATIONAL MANGER)
(619) 576-6887
Entity
Organization
Contact information
Practice address
6160 SUMMIT DR N STE 200, BROOKLYN CENTER, MN 55430-2181
(619) 576-6887
Mailing address
6160 SUMMIT DR N, SUITE 200 OFFICE #219, BROOKLYN CENTER, MN 55430
(619) 576-6887
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
11/05/2024
Last updated
11/05/2024
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