| The Bridge Autism Clinic Llc | |
|
690 Cleveland Ave South Suite 100 St Paul MN 55116 | |
| (612) 216-4647 | |
| Not Available |
| Full Name | The Bridge Autism Clinic Llc |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 690 Cleveland Ave South, St Paul, Minnesota |
| Authorized Official Name and Position | Melissa Hamilton (DIRECTOR CEO) |
| Authorized Official Contact | 6514938412 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Bridge Autism Clinic Llc 690 Cleveland Ave S # 100 Saint Paul MN 55116-1319 Ph: () - | The Bridge Autism Clinic Llc 690 Cleveland Ave South Suite 100 St Paul MN 55116 Ph: (612) 216-4647 |
| NPI Number | 1568017374 |
|---|---|
| Provider Enumeration Date | 08/08/2019 |
| Last Update Date | 12/10/2019 |
| Certification Date | 12/10/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568017374 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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