Healthcare Provider Details

I. General information

NPI: 1093222101
Provider Name (Legal Business Name): LAUREN BONNEAU BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2018
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19437 EVANS ST NW
ELK RIVER MN
55330-1074
US

IV. Provider business mailing address

4916 ALDRICH AVE N
MINNEAPOLIS MN
55430-3533
US

V. Phone/Fax

Practice location:
  • Phone: 763-515-3532
  • Fax:
Mailing address:
  • Phone: 407-821-6518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA0626
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: