NPIMap

Organization Active NPI

South Lake Autism Center L. L. C.

  • Clinic/Center
  • Saint Paul, MN
National Provider Identifier
1992521116
Registry record updated Feb 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
SOUTH LAKE AUTISM CENTER L. L. C.
Practice address
2147 University Ave W Ste 109
Saint Paul, MN 55114-1326
Phone
(617) 992-1536
NPI assigned
Dec 3, 2024
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Shikhdoon Jama Warsame
Title
Owner
Phone
(617) 992-1536

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

National Provider Directory

Locations

2147 University Ave W
Ste 108
Saint Paul, MN 55114
Phone (617) 992-1536

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

NPPES NPI Registry

Primary practice location

2147 University Ave W Ste 109
Saint Paul, MN 55114-1326

Mailing address

2147 University Ave W Ste 108
Saint Paul, MN 55114-1326
Phone (617) 992-1536

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 17, 2025.

{
    "created_epoch": "1733184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739750400000",
    "number": "1992521116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2147 UNIVERSITY AVE W STE 108",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551141326",
            "telephone_number": "617-992-1536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2147 UNIVERSITY AVE W STE 109",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551141326",
            "telephone_number": "617-992-1536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH LAKE AUTISM CENTER L. L. C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-03",
        "last_updated": "2025-02-17",
        "certification_date": "2025-02-17",
        "status": "A",
        "authorized_official_last_name": "WARSAME",
        "authorized_official_first_name": "SHIKHDOON",
        "authorized_official_middle_name": "JAMA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "617-992-1536"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2025; 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.