Healthcare Provider Details

I. General information

NPI: 1922861608
Provider Name (Legal Business Name): ADELINE KATHLEEN PRZYBILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 ROUND LAKE BLVD NW
ANOKA MN
55303-3315
US

IV. Provider business mailing address

3401 ROUND LAKE BLVD NW
ANOKA MN
55303-3315
US

V. Phone/Fax

Practice location:
  • Phone: 952-247-3582
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90814
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: