Individual
ABASE ABASE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11972 PORTLAND AVE, BURNSVILLE, MN 55337-1516
(952) 658-8670
Mailing address
11972 PORTLAND AVE, BURNSVILLE, MN 55337-1516
(952) 658-8670
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/23/2025
Last updated
05/23/2025
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