MEDICARE: EVOLVE ABA CARE

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1366329526
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVOLVE ABA CARE

Provider Business Mailing Address
First Line	:	2909 WAYZATA BLVD
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55405-2126
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2909 WAYZATA BLVD
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55405-2126
Country	:	US
Telephone Number	:	347-786-1504
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	LAZER BERGER
Credential	:
Telephone Number	:	347-786-1504

Provider Enumeration Date	:	08/19/2025
Last Update Date	:	08/19/2025

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