Willmar Autism Services LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

WILLMAR AUTISM SERVICES LLC

Doing business as

Willmar Autism Services LLC

Practice address

425 Benson Ave SW
Willmar, MN 56201-3235

Phone

(612) 570-5018

NPI assigned

Jun 12, 2020

Last updated

Jun 12, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Rashad Gabose, MSW, LGSW

Title

Ceo/Programm Manager

Phone

(612) 570-5018

Specialties & licenses 1

Addresses

Other names 1

• Willmar Autism Services LLC Doing business as

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

{
    "created_epoch": "1591920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591920000000",
    "number": "1831714195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 BENSON AVE SW",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "562013235",
            "telephone_number": "612-570-5018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 BENSON AVE SW",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "562013235",
            "telephone_number": "612-570-5018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLMAR AUTISM SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-12",
        "last_updated": "2020-06-12",
        "certification_date": "2020-06-12",
        "status": "A",
        "authorized_official_last_name": "GABOSE",
        "authorized_official_first_name": "RASHAD",
        "authorized_official_title_or_position": "CEO/PROGRAMM MANAGER",
        "authorized_official_telephone_number": "612-570-5018",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSW, LGSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willmar Autism Services LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cory James Wiegman, PTA
• Brenda Wiese, MSW LICSW
• Deanna Wilde, MSW, LICSW
• Priscilla K Willander, PA-C
• Kristen Anne Williamson, RD, LDN
• Willmar Care Center LLC
• Willmar Chiropractic Clinic P.a.
• Willmar Commons Nursing & Rehabilitation, Inc.
• Willmar Dental Clinic
• Willmar Family Dentistry, P.a.

• Community/Behavioral Health Agency in Willmar, MN
• Providers in Willmar, MN by specialty
• Community/Behavioral Health Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2020; 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.