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NPI 1417740424 · Behavior Technician · Burnsville, MN
Provider details
- NPI number
- 1417740424
- Entity type
- Individual
- Primary specialty
- Behavior TechnicianBehavioral Health & Social Service Providers
- Sex
- Male
- Sole proprietor
- Yes
Mailing address
11972 Portland Ave
Burnsville, MN 55337-1516
Registry dates
- Enumerated
- 2025-05-23
- Last updated
- 2025-05-23
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.