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Individual

KATLYN TENNYSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
7001 E FISH LAKE RD, MAPLE GROVE, MN 55311-2841
(508) 768-8008
Mailing address
199 SOUTH ST, NORTHBOROUGH, MA 01532-2330
(508) 768-8008

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-19-38331
MN
103K00000X
Behavior Analyst
2950-MH-B1
MA
106S00000X
Behavior Technician

Other

Enumeration date
07/03/2019
Last updated
10/24/2023
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