Minnesota Early Autism Project

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

MINNESOTA EARLY AUTISM PROJECT

Practice address

7236 Forestview LN N
Maple Grove, MN 55369-5656

Phone

(763) 493-7935

Fax

(763) 493-7936

NPI assigned

Sep 25, 2007

Last updated

Sep 25, 2007By 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

Kim Lauree Schutt-Chardon

Title

Director of Billing

Phone

(608) 288-9040

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1190678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190678400000",
    "number": "1902093834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6402 ODANA RD",
            "address_2": "ATTN: WEAP",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537191123",
            "telephone_number": "608-288-9040",
            "fax_number": "608-288-9042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7236 FORESTVIEW LN N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553695656",
            "telephone_number": "763-493-7935",
            "fax_number": "763-493-7936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNESOTA EARLY AUTISM PROJECT",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-25",
        "last_updated": "2007-09-25",
        "status": "A",
        "authorized_official_last_name": "SCHUTT-CHARDON",
        "authorized_official_first_name": "KIM",
        "authorized_official_middle_name": "LAUREE",
        "authorized_official_title_or_position": "DIRECTOR OF BILLING",
        "authorized_official_telephone_number": "608-288-9040"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Maple Grove, MN
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• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2007; 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.