MEDICARE: ANNIE MAY XIONG

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	CC04864	MN

General Provider Information

NPI Number	:	1578056313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNIE MAY XIONG

Provider Business Mailing Address
First Line	:	14301 EWING AVE S
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55306-4885
Country	:	US
Telephone Number	:	952-746-5365
Fax Number	:

Provider Business Practice Location Address
First Line	:	1231 8TH ST SE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55414-4600
Country	:	US
Telephone Number	:	715-551-9653
Fax Number	:

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

Provider Enumeration Date	:	06/06/2018
Last Update Date	:	02/12/2026

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