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General NPI Number Information
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NPI Number | 1427785021
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Entity Type | Organization
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Legal Business Name | NORTHERN STAR BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 08/03/2022
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Last Update Date | 08/03/2022
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Provider Practice Location Address
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Address Line | 111 RIVERFRONT STE 410
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City | WINONA
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State | MN
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Zip | 55987-3563
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Country | US
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Telephone | 507-218-1002
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Fax |
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Provider Business Mailing Address
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Address Line | 718 NEVILLE CT SE
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City | ROCHESTER
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State | MN
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Zip | 55904-4910
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MEAGAN PITTELKO
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Credential | M.ED., BCBA
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Telephone | 507-218-1002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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