Kellie Baker

Individual provider Active NPI Behavior Technician · Rogers, MN

NPI 1083315410 · NPPES record last updated Mar 13, 2023

Key facts

NPI
1083315410
Entity type
Individual (NPI type 1)
Primary specialty
Behavior Technician 106S00000X
Practice address
14000 Northdale Blvd Ste a
Rogers, MN 55374-4663
Phone
(952) 544-0349
NPI assigned
Mar 13, 2023
Sex
Female
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Practice roles

OrganizationSpecialtyStatusNew patients
Autism Matters, Inc. Past
since Mar 19, 2023
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X Yes

Addresses

Primary practice location

14000 Northdale Blvd Ste a
Rogers, MN 55374-4663

Mailing address

14000 Northdale Blvd Ste a
Rogers, MN 55374-4663
Phone (952) 544-0349

Other providers in Rogers, MN

All providers in Rogers, MN · Behavior Technician in Minnesota

Sources for this page

Verify at the official NPI Registry.