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NPI Code Detail

MEDICARE: AVERY ELIZABETH MCDONNELL

MEDICARE: AVERY ELIZABETH MCDONNELL
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 : 1699604850
Entity Type Code : Individual
Provider Name (Legal Business Name) : AVERY ELIZABETH MCDONNELL
Provider Business Mailing Address
First Line : 3007 HARBOR LN N
Second Line :
City : PLYMOUTH
State : MN
Zip : 55447-5112
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3007 HARBOR LN N
Second Line :
City : PLYMOUTH
State : MN
Zip : 55447-5112
Country : US
Telephone Number : 310-856-0800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2026
Last Update Date : 05/14/2026

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Directions to “ AVERY ELIZABETH MCDONNELL ” Practice Location

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