Facts
- Status
- A
- Credential
- BCBA
- Type
- Individual
- Enumeration date
- 2019-01-30
- Last updated
- 2024-06-20
Specialties
Licenses
- License SD
- 014
Location
- Practice location
- 2419 WASHINGTON AVE.
- City
- MONTEVIDEO MN
- Postal code
- 56265
- Phone
- 320-321-9732
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.