Healthcare Provider Details

I. General information

NPI: 1013811884
Provider Name (Legal Business Name): TIMIA DONNA-MARIE MONTALVO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 GLENN RD NW
ALEXANDRIA MN
56308-4007
US

IV. Provider business mailing address

59 GLENN RD NW
ALEXANDRIA MN
56308-4007
US

V. Phone/Fax

Practice location:
  • Phone: 320-219-7644
  • Fax: 320-219-7818
Mailing address:
  • Phone: 320-219-7644
  • Fax: 320-219-7818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: