MEDICARE: ANNA ELIZABETH MCLANE MA, BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103K00000X	Behavior Analyst
2	222Q00000X	Developmental Therapist
3	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1922504018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA ELIZABETH MCLANE MA, BCBA

Provider Business Mailing Address
First Line	:	1905 S TOPAZ WAY STE 100
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-4112
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1011 MEADOWLANDS DR STE 1AND2
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55127-2339
Country	:	US
Telephone Number	:	320-894-1876
Fax Number	:

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

Provider Enumeration Date	:	04/05/2018
Last Update Date	:	02/02/2026

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