MEDICARE: TESS GARTENBERG BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-16-22659	TX

General Provider Information

NPI Number	:	1023461324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TESS GARTENBERG BCBA

Provider Business Mailing Address
First Line	:	2115 E 35TH ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-2444
Country	:	US
Telephone Number	:	414-232-5534
Fax Number	:

Provider Business Practice Location Address
First Line	:	2905 NORTHWEST BLVD
Second Line	:
City	:	PLYMOUTH
State	:	MN
Zip	:	55441-7400
Country	:	US
Telephone Number	:	612-355-8868
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2016
Last Update Date	:	11/15/2023

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Directions to “ TESS GARTENBERG BCBA” Practice Location

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