Organization
SOUTH LAKE AUTISM CENTER L. L. C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHIKHDOON JAMA WARSAME (OWNER)
(617) 992-1536
Entity
Organization
Contact information
Practice address
2147 UNIVERSITY AVE W STE 109, SAINT PAUL, MN 55114-1326
(617) 992-1536
Mailing address
2147 UNIVERSITY AVE W STE 108, SAINT PAUL, MN 55114-1326
(617) 992-1536
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
12/03/2024
Last updated
02/17/2025
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