Most Relevant Information
Provider Data
| NPI Number: | 1003552621 |
| Provider Name: | AVALON SIDNEY |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/06/2022 |
| Last Updated: | 05/06/2022 |
Provider Practice Location
3007 HARBOR LN N STE 1200
PLYMOUTH
MN
554475103
Practice Location Phone/Fax
| Phone: | 6124395650 |
| Fax: |
Provider Mailing Location
11715 CHAMPLIN DR APT 308
CHAMPLIN
MN
553162386
Provider Mailing Phone/Fax
| Phone: | 6127028849 |
| Fax: |