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NPI Code Detail

MEDICARE: CARRIE ANN BROOKS BONDE BCBA

MEDICARE: CARRIE ANN BROOKS BONDE 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
1103K00000XBehavior Analyst1-11-9325MN

General Provider Information

NPI Number : 1235400425
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARRIE ANN BROOKS BONDE BCBA
Provider Business Mailing Address
First Line : 6211 EDGEMONT BLVD N
Second Line :
City : BROOKLYN PARK
State : MN
Zip : 55428-2654
Country : US
Telephone Number : 612-860-7006
Fax Number :
Provider Business Practice Location Address
First Line : 9120 SPRINGBROOK DR NW
Second Line :
City : COON RAPIDS
State : MN
Zip : 55433-5845
Country : US
Telephone Number : 612-331-9413
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2012
Last Update Date : 06/21/2019

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