Provider Demographics
NPI:1255041992
Name:FOUNDATIONS AUTISM CENTER, PLLC
Entity type:Organization
Organization Name:FOUNDATIONS AUTISM CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WAINRIGHT-TADYCH
Authorized Official - Suffix:
Authorized Official - Credentials:LP
Authorized Official - Phone:320-290-0693
Mailing Address - Street 1:2607 REGAL RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-9055
Mailing Address - Country:US
Mailing Address - Phone:320-290-0693
Mailing Address - Fax:
Practice Address - Street 1:1908 KRUCHTEN CT S
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-4645
Practice Address - Country:US
Practice Address - Phone:320-290-0693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health