Individual provider Active NPI

Mercedez Real

  • Behavior Technician
  • Woodbury, MN
National Provider Identifier
1104703784
Registry record updated Aug 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior TechnicianTaxonomy code 106S00000X
Practice address
748 Bielenberg Dr Ste 140
Woodbury, MN 55125-1407
Phone
(952) 955-4057
NPI assigned
Aug 18, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 18, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X MN Primary

Addresses

Primary practice location

748 Bielenberg Dr Ste 140
Woodbury, MN 55125-1407

Mailing address

1151 County Road D E
Saint Paul, MN 55109-5257
Phone (651) 428-0513

Medicare participation

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1755475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755475200000",
    "number": "1104703784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1151 COUNTY ROAD D E",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551095257",
            "telephone_number": "651-428-0513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "748 BIELENBERG DR STE 140",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551251407",
            "telephone_number": "952-955-4057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REAL",
        "first_name": "MERCEDEZ",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-08-18",
        "last_updated": "2025-08-18",
        "certification_date": "2025-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbury, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.