Provider Demographics
NPI:1326612144
Name:DULL, BRITTA KRISTINE
Entity Type:Individual
Prefix:
First Name:BRITTA
Middle Name:KRISTINE
Last Name:DULL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRITTA
Other - Middle Name:KRISTINE
Other - Last Name:LUNDGREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2225 JEFFERY ALLEN DR APT 202
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-4922
Mailing Address - Country:US
Mailing Address - Phone:507-923-7362
Mailing Address - Fax:
Practice Address - Street 1:5501 FELTL RD
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-3944
Practice Address - Country:US
Practice Address - Phone:612-416-1301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103K00000X, 106S00000X
103K00000X, 106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst