MEDICARE: MARIETTA NEL HEMMING M. ED.

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	:	1699063727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIETTA NEL HEMMING M. ED.

Provider Business Mailing Address
First Line	:	3278 ALDEN POND LN
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55121-2816
Country	:	US
Telephone Number	:	651-263-5697
Fax Number	:

Provider Business Practice Location Address
First Line	:	1160 CENTRE POINTE DRIVE
Second Line	:	STE 7
City	:	MENDOTA HEIGHTS
State	:	MN
Zip	:	55120
Country	:	US
Telephone Number	:	952-401-9359
Fax Number	:

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

Provider Enumeration Date	:	07/11/2011
Last Update Date	:	01/28/2025

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