MEDICARE: MARIKA REESE LICSW, 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
1	103K00000X	Behavior Analyst	1-23-69783	MN
2	1041C0700X	Clinical Social Worker	32960	MN

General Provider Information

NPI Number	:	1316694870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIKA REESE LICSW, BCBA

Provider Business Mailing Address
First Line	:	310 E 38TH ST STE 220A
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55409-1455
Country	:	US
Telephone Number	:	651-410-8148
Fax Number	:	612-465-3420

Provider Business Practice Location Address
First Line	:	310 E 38TH ST STE 220A
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55409-1455
Country	:	US
Telephone Number	:	651-410-8148
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2022
Last Update Date	:	04/16/2026

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