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NPI Code Detail

MEDICARE: BENJAMIN LEE CONRAD

MEDICARE: BENJAMIN LEE CONRAD
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 TechnicianMN

General Provider Information

NPI Number : 1770439770
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENJAMIN LEE CONRAD
Provider Business Mailing Address
First Line : 7615 GOLDEN TRIANGLE DR STE A
Second Line :
City : EDEN PRAIRIE
State : MN
Zip : 55344-3733
Country : US
Telephone Number : 952-767-2974
Fax Number :
Provider Business Practice Location Address
First Line : 7615 GOLDEN TRIANGLE DR STE A
Second Line :
City : EDEN PRAIRIE
State : MN
Zip : 55344-3733
Country : US
Telephone Number : 952-767-2974
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2026
Last Update Date : 03/10/2026

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