Individual
CHARLES JOHN POTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4635 NICOLS RD APT 104, EAGAN, MN 55122-3337
(612) 289-6480
Mailing address
4635 NICOLS RD APT 104, EAGAN, MN 55122-3337
(612) 289-6480
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
08/25/2025
Last updated
08/25/2025
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