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NPI Code Detail

MEDICARE: EMILY ROSE FADNESS

MEDICARE: EMILY ROSE FADNESS
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
1106S00000XBehavior TechnicianMN

General Provider Information

NPI Number : 1114855236
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY ROSE FADNESS
Provider Business Mailing Address
First Line : 624 KNIGHT ST APT 107
Second Line :
City : SAINT PETER
State : MN
Zip : 56082-1760
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1701 ADAMS ST
Second Line :
City : MANKATO
State : MN
Zip : 56001-4895
Country : US
Telephone Number : 507-565-0150
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2026
Last Update Date : 05/11/2026

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Directions to “ EMILY ROSE FADNESS ” Practice Location

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