Healthcare Provider Details

I. General information

NPI: 1760318711
Provider Name (Legal Business Name): JOSHUA WILLIAM PEIFFER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9012 CAHILL AVE
INVER GROVE HEIGHTS MN
55076-3543
US

IV. Provider business mailing address

839 DORLAND RD S
MAPLEWOOD MN
55119-5837
US

V. Phone/Fax

Practice location:
  • Phone: 651-350-7968
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: