Healthcare Provider Details

I. General information

NPI: 1447173802
Provider Name (Legal Business Name): BENJAMIN JOHN SPEIKER MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3754 PLEASANT AVE STE 205
MINNEAPOLIS MN
55409-1279
US

IV. Provider business mailing address

3754 PLEASANT AVE STE 205
MINNEAPOLIS MN
55409-1279
US

V. Phone/Fax

Practice location:
  • Phone: 612-217-4210
  • Fax:
Mailing address:
  • Phone: 612-217-4210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3950
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: