MEDICARE: EMILY NIEMEYER BCABA

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	106E00000X	Assistant Behavior Analyst
2	103K00000X	Behavior Analyst	LBA0549	MN

General Provider Information

NPI Number	:	1588424329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY NIEMEYER BCABA

Provider Business Mailing Address
First Line	:	15580 WING LAKE DR
Second Line	:
City	:	MINNETONKA
State	:	MN
Zip	:	55345-5647
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15580 WING LAKE DR
Second Line	:
City	:	MINNETONKA
State	:	MN
Zip	:	55345-5647
Country	:	US
Telephone Number	:	612-867-8466
Fax Number	:

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

Provider Enumeration Date	:	03/20/2024
Last Update Date	:	07/10/2025

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