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NPI Code Detail

MEDICARE: TYLER KELLY KRUEGER BCBA

MEDICARE: TYLER KELLY KRUEGER 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 Analyst1-12-10041
2103K00000XBehavior Analyst1-12-10041WI
3103K00000XBehavior Analyst1-12-10041MN

General Provider Information

NPI Number : 1356615488
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYLER KELLY KRUEGER BCBA
Provider Business Mailing Address
First Line : 957 ARMSTRONG AVE
Second Line :
City : SAINT PAUL
State : MN
Zip : 55102-3709
Country : US
Telephone Number : 920-664-3050
Fax Number :
Provider Business Practice Location Address
First Line : 2147 UNIVERSITY AVE W STE 205
Second Line :
City : SAINT PAUL
State : MN
Zip : 55114-1327
Country : US
Telephone Number : 920-664-3050
Fax Number : 651-352-2706
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2012
Last Update Date : 05/03/2024

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Directions to “ TYLER KELLY KRUEGER BCBA” Practice Location

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