Individual
DEEQO ABI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3055 OLD HIGHWAY 8, ST ANTHONY, MN 55418-2500
(612) 267-6293
Mailing address
333 RICE CREEK TER NE, FRIDLEY, MN 55432-4437
(612) 267-6293
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
MN
Other
Enumeration date
05/27/2024
Last updated
05/27/2024
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