Individual
TANYA MEDINA VASSALLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LBA, BCBA
Contact information
Practice address
5010 CHESHIRE LN N STE 1, PLYMOUTH, MN 55446-3863
(612) 439-4650
Mailing address
6233 RUSSELL AVE S, RICHFIELD, MN 55423-1003
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
LBA0719
MN
Other
Enumeration date
01/24/2022
Last updated
01/08/2026
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