Individual
EVA DASSIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6300 W OLD SHAKOPEE RD, BLOOMINGTON, MN 55438-2654
(612) 509-6671
Mailing address
6300 W OLD SHAKOPEE RD, BLOOMINGTON, MN 55438-2654
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1588993091
—
MN
Enumeration date
02/22/2021
Last updated
02/22/2021
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