Healthcare Provider Details

I. General information

NPI: 1134933401
Provider Name (Legal Business Name): ACTIVARIUM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 MAINSTREET
HOPKINS MN
55343-7565
US

IV. Provider business mailing address

100 W POINT RD
EXCELSIOR MN
55331-9421
US

V. Phone/Fax

Practice location:
  • Phone: 952-444-2808
  • Fax:
Mailing address:
  • Phone: 612-859-4509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: MS. ELIZABETH FLORENCE LOWERY
Title or Position: CEO
Credential:
Phone: 612-859-4509