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NPI Code Detail

MEDICARE: ANQUATIA FREEMAN

MEDICARE: ANQUATIA FREEMAN
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1578418661
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANQUATIA FREEMAN
Provider Business Mailing Address
First Line : 8061 LANDER AVE NE
Second Line :
City : OTSEGO
State : MN
Zip : 55330-1090
Country : US
Telephone Number : 763-501-4660
Fax Number :
Provider Business Practice Location Address
First Line : 12070 43RD ST NE STE 200
Second Line :
City : SAINT MICHAEL
State : MN
Zip : 55376-8427
Country : US
Telephone Number : 763-515-3150
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2026
Last Update Date : 03/03/2026

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Directions to “ ANQUATIA FREEMAN ” Practice Location

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