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NPI Code Detail

MEDICARE: JEREMY WEIS

MEDICARE: JEREMY WEIS
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 Technician

General Provider Information

NPI Number : 1164121844
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEREMY WEIS
Provider Business Mailing Address
First Line : 5215 EDINA INDUSTRIAL BLVD STE 200
Second Line :
City : EDINA
State : MN
Zip : 55439-2926
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5215 EDINA INDUSTRIAL BLVD
Second Line :
City : EDINA
State : MN
Zip : 55439-2926
Country : US
Telephone Number : 612-594-8405
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2023
Last Update Date : 03/01/2023

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Directions to “ JEREMY WEIS ” Practice Location

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