Individual
ELLA JEANNE RIVERA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Contact information
Practice address
1403 HERITAGE DR STE A, NORTHFIELD, MN 55057-3227
(763) 200-4374
Mailing address
2810 145TH ST W APT 206, ROSEMOUNT, MN 55068-4994
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
1407561582
MN
Other
Enumeration date
11/10/2025
Last updated
11/10/2025
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