Nyakume Dup

Individual provider Active NPI Behavior Technician · Mankato, MN

NPI 1265092563 · NPPES record last updated Jun 18, 2019

Key facts

NPI
1265092563
Entity type
Individual (NPI type 1)
Primary specialty
Behavior Technician 106S00000X
Practice address
220 E Main St Ste 1
Mankato, MN 56001-3574
Phone
(507) 345-7012
NPI assigned
Jun 18, 2019
Sex
Female
Sole proprietor
Yes

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
Five Rivers Mental Health LLC Past
since Nov 17, 2019
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X Yes

Addresses

Primary practice location

220 E Main St Ste 1
Mankato, MN 56001-3574

Mailing address

237 S Pearl St
Albert Lea, MN 56007-2644
Phone (507) 369-4489

Other providers in Mankato, MN

All providers in Mankato, MN · Behavior Technician in Minnesota

Sources for this page

Verify at the official NPI Registry.