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NPI Code Detail

MEDICARE: MIKAELA GUSTAFSON

MEDICARE: MIKAELA GUSTAFSON
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 : 1871426833
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIKAELA GUSTAFSON
Provider Business Mailing Address
First Line : 901 9TH AVE N UNIT A
Second Line :
City : PRINCETON
State : MN
Zip : 55371-1236
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1994 E RUM RIVER DR S
Second Line :
City : CAMBRIDGE
State : MN
Zip : 55008-2663
Country : US
Telephone Number : 763-689-5385
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2026
Last Update Date : 06/08/2026

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Directions to “ MIKAELA GUSTAFSON ” Practice Location

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