Healthcare Provider Details

I. General information

NPI: 1144862046
Provider Name (Legal Business Name): LYNDSEY FROGNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2019
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14000 NORTHDALE BLVD STE A
ROGERS MN
55374-4663
US

IV. Provider business mailing address

19437 EVANS ST NW
ELK RIVER MN
55330-1074
US

V. Phone/Fax

Practice location:
  • Phone: 763-428-2478
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA0025
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: