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NPI Code Detail

MEDICARE: BLAKE JOHN PAUL BETCHER

MEDICARE: BLAKE JOHN PAUL BETCHER
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 Analyst1491-140WI

General Provider Information

NPI Number : 1255077855
Entity Type Code : Individual
Provider Name (Legal Business Name) : BLAKE JOHN PAUL BETCHER
Provider Business Mailing Address
First Line : 14301 EWING AVE S
Second Line :
City : BURNSVILLE
State : MN
Zip : 55306-4885
Country : US
Telephone Number : 952-746-5350
Fax Number :
Provider Business Practice Location Address
First Line : 223 CENTER ST
Second Line :
City : WINONA
State : MN
Zip : 55987-3595
Country : US
Telephone Number : 507-474-4840
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2022
Last Update Date : 01/26/2026

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Directions to “ BLAKE JOHN PAUL BETCHER ” Practice Location

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