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NPI Code Detail

MEDICARE: MS. SHAWN N GIRTLER MS, BCBA

MEDICARE: MS. SHAWN N GIRTLER MS, 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 Analyst

General Provider Information

NPI Number : 1255675419
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SHAWN N GIRTLER MS, BCBA
Provider Business Mailing Address
First Line : 9120 SPRINGBROOK DR NW
Second Line :
City : COON RAPIDS
State : MN
Zip : 55433-5845
Country : US
Telephone Number : 612-767-7222
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 : 612-767-7222
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/12/2012
Last Update Date : 03/29/2019

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