Organization
MIND SPARKS L. L. C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MUNA MOHAMED JEDAL (AUTHORIZED AGENT)
(612) 281-6238
Entity
Organization
Contact information
Practice address
19344 136TH AVE N, ROGERS, MN 55374-4848
(612) 281-6238
Mailing address
19344 136TH AVE N, ROGERS, MN 55374-4848
(612) 281-6238
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
06/27/2025
Last updated
06/27/2025
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