Individual
ELIZABETH TIFFANY KOOISTRA-CASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., BCBA
Contact information
Practice address
10450 185TH ST W, LAKEVILLE, MN 55044-6686
(612) 509-6686
Mailing address
10450 185TH ST W, LAKEVILLE, MN 55044-6686
(612) 270-7015
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
03/01/2012
Last updated
07/02/2024
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