Basic Information
| Provider Information | |||||||||
| NPI: | 1225136419 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WASHBURN CENTER FOR CHILDREN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 GLENWOOD AVE | ||||||||
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| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128711454 | ||||||||
| FaxNumber: | 6128711505 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 GLENWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128711454 | ||||||||
| FaxNumber: | 6128711505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 10/22/2015 | ||||||||
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| AuthorizedOfficialLastName: | LEPINSKI | ||||||||
| AuthorizedOfficialFirstName: | STEVE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6128723322 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0855X | 802629 | MN | Y | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |
No ID Information.