MEDICARE: VANESSA EEKHOFF

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	BACB595612	MN

General Provider Information

NPI Number	:	1780426510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA EEKHOFF

Provider Business Mailing Address
First Line	:	15801 DOCKEN DR
Second Line	:
City	:	MILACA
State	:	MN
Zip	:	56353-3705
Country	:	US
Telephone Number	:	231-903-7155
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 4TH AVE NE
Second Line	:
City	:	SIOUX CENTER
State	:	IA
Zip	:	51250-1609
Country	:	US
Telephone Number	:	712-722-6951
Fax Number	:

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

Provider Enumeration Date	:	06/11/2024
Last Update Date	:	06/11/2024

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Directions to “ VANESSA EEKHOFF ” Practice Location

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