Healthcare Provider Details

I. General information

NPI: 1427785021
Provider Name (Legal Business Name): NORTHERN STAR BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 RIVERFRONT STE 410
WINONA MN
55987-3563
US

IV. Provider business mailing address

718 NEVILLE CT SE
ROCHESTER MN
55904-4910
US

V. Phone/Fax

Practice location:
  • Phone: 507-218-1002
  • Fax:
Mailing address:
  • Phone:
  • 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 Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MEAGAN PITTELKO
Title or Position: OWNER
Credential: M.ED., BCBA
Phone: 507-218-1002