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NPI Code Detail

MEDICARE: EMILY BRISTLIN BCBA

MEDICARE: EMILY BRISTLIN BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-18-71358
2103K00000XBehavior Analyst

General Provider Information

NPI Number : 1164992848
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY BRISTLIN BCBA
Provider Business Mailing Address
First Line : 301 MCANDREWS RD W APT 120
Second Line :
City : BURNSVILLE
State : MN
Zip : 55337-8302
Country : US
Telephone Number : 651-361-0365
Fax Number :
Provider Business Practice Location Address
First Line : 10450 185TH ST W STE 100
Second Line :
City : LAKEVILLE
State : MN
Zip : 55044-6696
Country : US
Telephone Number : 612-509-1283
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/26/2018
Last Update Date : 08/10/2021

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