Maia Eliz Defoe
Individual provider Active NPI Behavior Technician · Hermantown, MN
NPI 1841924461 · NPPES record last updated Jul 11, 2022
Key facts
- NPI
- 1841924461
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Technician 106S00000X
- Practice address
- 4140 Richard Ave Ste 200
Hermantown, MN 55811-3309 - Phone
- (218) 514-5230
- NPI assigned
- Jul 11, 2022
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Yes |
Addresses
Primary practice location
4140 Richard Ave Ste 200
Hermantown, MN 55811-3309
Mailing address
2104 E 8TH St
Duluth, MN 55812-1353
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588993091 | Medicaid | MN |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | hrhelp@caravelautism.com | Direct |
Other providers in Hermantown, MN
- Jennifer Nicole Dagger
- Miranda Lou Dahl
- Stephen Glenn Dahlgren
- Ashley Dammer
- Bailey Ann Dee
- Ronald Lee Defrance
- Sitasravya Devathi
- Directions for Life Pca Services
- Directions for Life Pca Services, LLC
- Jocelyn A. Dorscher
All providers in Hermantown, MN · Behavior Technician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 11, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.