MEDICARE: MS. LAUREN BONNEAU 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	LBA0626	MN

General Provider Information

NPI Number	:	1093222101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAUREN BONNEAU BCBA

Provider Business Mailing Address
First Line	:	4916 ALDRICH AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55430-3533
Country	:	US
Telephone Number	:	407-821-6518
Fax Number	:

Provider Business Practice Location Address
First Line	:	19437 EVANS ST NW
Second Line	:
City	:	ELK RIVER
State	:	MN
Zip	:	55330-1074
Country	:	US
Telephone Number	:	763-515-3532
Fax Number	:

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

Provider Enumeration Date	:	01/10/2018
Last Update Date	:	05/22/2026

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