Healthcare Provider Details

I. General information

NPI: 1336017409
Provider Name (Legal Business Name): AVIATION ABA THERAPY MN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2025
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4517 MINNETONKA BLVD STE 300
MINNEAPOLIS MN
55416-5411
US

IV. Provider business mailing address

88 WASHINGTON AVE
CEDARHURST NY
11516-1902
US

V. Phone/Fax

Practice location:
  • Phone: 801-875-1317
  • Fax:
Mailing address:
  • Phone: 801-875-1317
  • 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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: REUVEN ROBERTS
Title or Position: CEO
Credential:
Phone: 801-875-1317