Lake Autism Center Inc

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

Legal business name

LAKE AUTISM CENTER INC

Practice address

1330 Lagoon Ave Ste 425
Minneapolis, MN 55408-2885

Phone

(952) 200-3684

NPI assigned

May 8, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Amina Mohamud Mohamed

Title

Owner

Phone

(952) 200-3664

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1715126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715126400000",
    "number": "1639927239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1330 LAGOON AVE STE 425",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554082885",
            "telephone_number": "952-200-3684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1330 LAGOON AVE STE 425",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554082885",
            "telephone_number": "952-200-3684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE AUTISM CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-08",
        "last_updated": "2024-05-08",
        "certification_date": "2024-05-08",
        "status": "A",
        "authorized_official_last_name": "MOHAMED",
        "authorized_official_first_name": "AMINA",
        "authorized_official_middle_name": "MOHAMUD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "952-200-3664"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Early Intervention Provider Agency in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Early Intervention Provider Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.