MEDICARE: TARA MIKENAS

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
1	106S00000X	Behavior Technician		MN

General Provider Information

NPI Number	:	1265386460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA MIKENAS

Provider Business Mailing Address
First Line	:	740 E 17TH ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-1601
Country	:	US
Telephone Number	:	763-244-6126
Fax Number	:

Provider Business Practice Location Address
First Line	:	4130 BLACKHAWK RD # ID
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55122-1700
Country	:	US
Telephone Number	:	651-381-1536
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2026
Last Update Date	:	02/24/2026

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Directions to “ TARA MIKENAS ” Practice Location

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