NORTH DAKOTA AUTISM CENTER, INC (NPI# 1104081116) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104081116 |
| Entity Type | Organization |
| Organization Name | NORTH DAKOTA AUTISM CENTER, INC |
| Practice Address |
647 13th Ave E Ste A West Fargo ND 58078-3328 |
| Practice Telephone | 7012778844 |
| Practice Fax Number | 7012778847 |
| Mailing Telephone | 7012778844 |
| Mailing Fax Number | 7012778847 |
| Enumeration Date | 2008-07-20 |
| Last Update Date | 2017-09-14 |
| Authorized Official Name | SANDY A SMITH (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 7012778844 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103K00000X | Behavioral Analyst | Behavioral Health & Social Service Providers | ||
| Y | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
Ambulatory Health Care Facilities |
| Street Address |
647 13TH AVE E STE A |
| City | WEST FARGO |
| State | ND |
| Zip Code | 58078-3328 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265041404 | Brian Kauffman | Behavior Technician | 647 13th Ave E, West Fargo, ND 58078-3328 | 2020-07-23 |
| 1982213112 | Madeline Wickoren | Behavior Technician | 647 13th Ave E, West Fargo, ND 58078-3328 | 2020-07-23 |
| 1154930303 | Sarah Rohr | Behavior Technician | 647 13th Ave E, West Fargo, ND 58078-3328 | 2020-07-23 |
| 1558970798 | Hannah Jensen | Behavior Technician | 647 13th Ave E, West Fargo, ND 58078-3328 | 2020-07-23 |
| 1346866159 | Megan Berginski | Behavior Technician | 647 13th Ave E, West Fargo, ND 58078-3328 | 2020-06-18 |
| 1801412614 | Mariah Almklov | Behavior Technician | 647 13th Ave E, West Fargo, ND 58078-3328 | 2020-06-18 |
| 1346865086 | Nevin Fetzer | Behavior Technician | 647 13th Ave E, West Fargo, ND 58078-3328 | 2020-06-09 |
| 1306461025 | Chloe Lear | Behavior Technician | 647 13th Ave E, West Fargo, ND 58078-3328 | 2020-06-09 |
| 1831714575 | Jennifer Petrock | Behavior Technician | 647 13th Ave E, West Fargo, ND 58078-3328 | 2020-06-09 |
| 1316569288 | Ariel Iglehart | Behavior Technician | 647 13th Ave E, West Fargo, ND 58078-3328 | 2020-05-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982205068 | Ashley Kasson Therapy | Counselor | 3220 4th St E, West Fargo, ND 58078 | 2020-11-04 |
| 1427658624 | Deedee (dorin) Ngwe | Technician | 3240 9th S West Apt. 204, West Fargo, ND 58078 | 2020-10-27 |
| 1053879734 | Mpnd,inc | Pharmacy | 2050 Sheyenne Street, West Fargo, ND 58078 | 2019-03-12 |
| 1396239216 | Luke Gable | Behavior Technician | 647 13th Avenue South, West Fargo, ND 58078 | 2018-06-15 |
| 1629597919 | Cody Freng | Specialist/Technologist | 3276 9th St W Apt C, West Fargo, ND 58078 | 2017-09-18 |
| 1831613942 | Lauren Phyllis Loe | Physical Therapist | 1401 13th Avenue East, Essentia Health West Fargo Clinic, West Fargo, ND 58078 | 2017-07-31 |
| 1851746226 | Jodi Kilen | Occupational Therapy Assistant | 631 4th Ave East, West Fargo, ND 58078 | 2016-05-04 |
| 1922490101 | Betty Ann Helmer | Social Worker | 2355 Meadow Ridge Parkway, West Fargo, ND 58078 | 2015-02-25 |
| 1477972784 | Tessa Nicole Larson | Occupational Therapist | 3139 Bluestem Dr Ste 108, West Fargo, ND 58078 | 2014-04-15 |
| 1023432010 | Kaylyn Kortes | Licensed Practical Nurse | 1302 Sheyenne St, West Fargo, ND 58078 | 2014-02-11 |
| Find all providers in zip 58078 | ||||
| Taxonomy Code | 261QM0855X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Adolescent and Children Mental Health |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training. |
| Notes: [7/1/2003: new] |
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| 1750856761 | Opportunity Foundation Inc | Clinic/Center | 15 1st Ave Se, Stanley, ND 58784-9065 | 2018-10-05 |
| 1477937258 | Child & Adolescent Psychological Services, Inc. | Clinic/Center | 1705 4th Ave Nw, Minot, ND 58703-2912 | 2015-07-12 |
| 1720413461 | April Wilson-warren Np-c Pllc | Clinic/Center | 315 Main St S Ste 301, Minot, ND 58701-3956 | 2013-09-12 |
| 1891069191 | St. James' of North Dakota, LLC | Clinic/Center | 1007 4th Ave S, Wishek, ND 58495-7527 | 2012-03-05 |
| 1538463401 | St James of Nd, LLC | Clinic/Center | 3000 North 14th Street, Suite 2a, Bismarck, ND 58503 | 2011-01-06 |
| 1225075906 | South Central Human Service Center | Clinic/Center | 520 3rd St Nw, Jamestown, ND 58401 | 2006-06-01 |
| City | WEST FARGO |
| Zip Code | 58078 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.