Ifrah A Jire

Individual provider Active NPI Behavior Technician · Coon Rapids, MN

NPI 1962279620 · NPPES record last updated Dec 4, 2023

Key facts

NPI
1962279620
Entity type
Individual (NPI type 1)
Primary specialty
Behavior Technician 106S00000X
Practice address
9120 Springbrook Dr NW
Coon Rapids, MN 55433-5845
Phone
(763) 231-2590
NPI assigned
Dec 4, 2023
Sex
Female
Sole proprietor
No

Organizations & group practices 2

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
Fraser Child and Family Center Current
since Dec 10, 2023
Accepting new patients
Fraser Past
since Dec 10, 2023
Accepting new patients

Locations

9120 Springbrook Dr NW
Minneapolis, MN 55433
Phone (763) 231-2590

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X Yes

Addresses

Primary practice location

9120 Springbrook Dr NW
Coon Rapids, MN 55433-5845

Mailing address

2390 Mounds View Blvd Apt 110
Saint Paul, MN 55112-0031

Other providers in Coon Rapids, MN

All providers in Coon Rapids, MN · Behavior Technician in Minnesota

Sources for this page

Verify at the official NPI Registry.