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NPI Code Detail

MEDICARE: QUEETY BADIO

MEDICARE: QUEETY BADIO
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1205468378
Entity Type Code : Individual
Provider Name (Legal Business Name) : QUEETY BADIO
Provider Business Mailing Address
First Line : 2340 STILLWATER AVE E
Second Line :
City : MAPLEWOOD
State : MN
Zip : 55119-3646
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6200 BURY DR
Second Line :
City : EDEN PRAIRIE
State : MN
Zip : 55346-1718
Country : US
Telephone Number : 866-822-7464
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2020
Last Update Date : 02/06/2020

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Directions to “ QUEETY BADIO ” Practice Location

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