Individual
AMINO UDD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4707 107TH AVE N, BROOKLYN PARK, MN 55443-5801
(612) 516-7382
Mailing address
4707 107TH AVE N, BROOKLYN PARK, MN 55443-5801
(612) 516-7382
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
02/17/2025
Last updated
02/17/2025
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