Healthcare Provider Details

I. General information

NPI: 1730061706
Provider Name (Legal Business Name): AMARION WASHINGTON
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 BIELENBERG DR # 102-105
WOODBURY MN
55125-1700
US

IV. Provider business mailing address

1519 MAGNOLIA AVE E APT 12
SAINT PAUL MN
55106-7002
US

V. Phone/Fax

Practice location:
  • Phone: 612-439-4653
  • Fax:
Mailing address:
  • Phone: 612-963-3756
  • 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: