Active NPI
Breanna Corder
- Behavior Technician
- Bloomington, MN
National Provider Identifier
1447848718
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 6300 W Old Shakopee Rd Ste 102
Bloomington, MN 55438-2684 - Phone
- (612) 509-6671
- NPI assigned
- Jan 4, 2021
- Sex
- Female
- Sole proprietor
- Yes
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 Technician | 106S00000X | Primary |
Addresses
Primary practice location
6300 W Old Shakopee Rd Ste 102
Bloomington, MN 55438-2684
Mailing address
3813 Baillif PL
Bloomington, MN 55431-3520
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| X234-247-257-109 | Other | MN | DRIVERS LICENSE NUMBER |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | bquarter0419@icloud.com |
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": "1609718400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609718400000",
"number": "1447848718",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3813 BAILLIF PL",
"city": "BLOOMINGTON",
"state": "MN",
"postal_code": "554313520"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6300 W OLD SHAKOPEE RD STE 102",
"city": "BLOOMINGTON",
"state": "MN",
"postal_code": "554382684",
"telephone_number": "612-509-6671"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORDER",
"first_name": "BREANNA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-01-04",
"last_updated": "2021-01-04",
"certification_date": "2021-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DRIVERS LICENSE NUMBER",
"identifier": "X234-247-257-109",
"state": "MN"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "bquarter0419@icloud.com",
"affiliation": "N",
"address_1": "6300 W Old Shakopee Rd Ste 102",
"city": "Bloomington",
"state": "MN",
"country_code": "US",
"postal_code": "554382684",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Bloomington, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.