Healthcare Provider Details

I. General information

NPI: 1396479986
Provider Name (Legal Business Name): CAYLA MCMORRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8980 ZACHARY LN N
MAPLE GROVE MN
55369-4018
US

IV. Provider business mailing address

8980 ZACHARY LN N
MAPLE GROVE MN
55369-4018
US

V. Phone/Fax

Practice location:
  • Phone: 763-231-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: