Individual
BOUBA DIALLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3401 ROUND LAKE BLVD NW, ANOKA, MN 55303-3315
(952) 247-3381
Mailing address
3401 ROUND LAKE BLVD NW, ANOKA, MN 55303-3315
(952) 247-3381
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
11/03/2025
Last updated
11/03/2025
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