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NPI Code Detail

MEDICARE: MIKENNA MARIE MORK MA, BCBA, LBA

MEDICARE: MIKENNA MARIE MORK MA, BCBA, LBA
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
1103K00000XBehavior AnalystLBA0126MN

General Provider Information

NPI Number : 1881286144
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIKENNA MARIE MORK MA, BCBA, LBA
Provider Business Mailing Address
First Line : 5010 CHESHIRE LN N STE 1
Second Line :
City : PLYMOUTH
State : MN
Zip : 55446-3863
Country : US
Telephone Number : 612-445-8316
Fax Number :
Provider Business Practice Location Address
First Line : 5010 CHESHIRE LN N STE 1
Second Line :
City : PLYMOUTH
State : MN
Zip : 55446-3863
Country : US
Telephone Number : 507-353-3012
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2021
Last Update Date : 12/05/2025

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