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NPI Code Detail

MEDICARE: JOETTLE BORWARD

MEDICARE: JOETTLE BORWARD
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 Technician

General Provider Information

NPI Number : 1750233193
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOETTLE BORWARD
Provider Business Mailing Address
First Line : 100 N PACIFIC COAST HWY STE 1400
Second Line :
City : EL SEGUNDO
State : CA
Zip : 90245-5602
Country : US
Telephone Number : 949-357-2556
Fax Number : 949-357-2556
Provider Business Practice Location Address
First Line : 13601 80TH CIR N STE 200
Second Line :
City : MAPLE GROVE
State : MN
Zip : 55369-9801
Country : US
Telephone Number : 763-272-5877
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2026
Last Update Date : 02/10/2026

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Directions to “ JOETTLE BORWARD ” Practice Location

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