Ethan Logan Stucker

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

1720 Bassett Dr
Mankato, MN 56001-6569

Phone

(507) 682-7100

NPI assigned

Jan 27, 2025

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Katherine Elizabeth Stucker Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1737936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737936000000",
    "number": "1467265389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 CAMPUS VIEW RD APT 5",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560016337",
            "telephone_number": "303-242-4422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 BASSETT DR",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560016569",
            "telephone_number": "507-682-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STUCKER",
        "first_name": "ETHAN",
        "middle_name": "LOGAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-01-27",
        "last_updated": "2025-01-27",
        "certification_date": "2025-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHERINE",
            "last_name": "STUCKER",
            "middle_name": "ELIZABETH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Gary James Stranik, D.D.S.
• Alexander Morgan Streeter
• Katharyn Kristin Stricklin, RN
• Alicia Marie Struck
• Laura Rae Struck, NP
• Kelly A Studer, RDN
• Taylor Sean Studsrud, MD
• Myrna B Stuefen, PAC
• Jennifer Lynn Stuvek, D.C.
• Kasey C Suckow, APRN

• Behavior Technician in Mankato, MN
• Providers in Mankato, MN by specialty
• Behavior Technician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 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.