Active NPI
Kaelan Rose Lucas, MA
- Behavior Analyst
- Fridley, MN
National Provider Identifier
1306567052
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- LBA0749
- Practice address
- 480 Osborne Rd NE Ste 260
Fridley, MN 55432-2866 - Phone
- (651) 243-6556
- Fax
- (855) 568-2494
- NPI assigned
- Sep 9, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | LBA0749 | MN | Primary |
Addresses
Primary practice location
480 Osborne Rd NE Ste 260
Fridley, MN 55432-2866
Mailing address
910 Aldine St
Saint Paul, MN 55104-1110
Phone (651) 348-9944
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LBA0749 | MN | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1662681600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1771286400000",
"number": "1306567052",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "910 ALDINE ST",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551041110",
"telephone_number": "651-348-9944"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "480 OSBORNE RD NE STE 260",
"city": "FRIDLEY",
"state": "MN",
"postal_code": "554322866",
"telephone_number": "651-243-6556",
"fax_number": "855-568-2494"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUCAS",
"first_name": "KAELAN",
"middle_name": "ROSE",
"credential": "MA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-09-09",
"last_updated": "2026-02-17",
"certification_date": "2026-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "MN",
"license": "LBA0749",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fridley, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.