MEDICARE: SONGBIRD HEALTH MN LLC

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

General Provider Information

NPI Number	:	1922694728
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SONGBIRD HEALTH MN LLC

Provider Business Mailing Address
First Line	:	400 S 4TH ST STE 410
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55415-1419
Country	:	US
Telephone Number	:	612-444-6661
Fax Number	:	833-392-1148

Provider Business Practice Location Address
First Line	:	400 S 4TH ST STE 410
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55415-1419
Country	:	US
Telephone Number	:	612-444-6661
Fax Number	:	833-392-1148

Authorized Official
Title or Position	:	CO-FOUNDER
Name	:	BENJAMIN HSU
Credential	:
Telephone Number	:	571-244-4592

Provider Enumeration Date	:	12/15/2020
Last Update Date	:	02/14/2022

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