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NPI Code Detail

MEDICARE: JENNY TRUE MOUA

MEDICARE:   JENNY TRUE MOUA
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 : 1730847807
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNY TRUE MOUA
Provider Business Mailing Address
First Line : 7915 IDAHO CIR N
Second Line :
City : BROOKLYN PARK
State : MN
Zip : 55445-2616
Country : US
Telephone Number : 612-540-9252
Fax Number :
Provider Business Practice Location Address
First Line : 7915 IDAHO CIR N
Second Line :
City : BROOKLYN PARK
State : MN
Zip : 55445-2616
Country : US
Telephone Number : 612-540-9252
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2021
Last Update Date : 12/08/2021

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Directions to “ JENNY TRUE MOUA ” Practice Location

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