Provider Demographics
NPI:1316694870
Name:REESE, MARIKA (BCBA)
Entity type:Individual
Prefix:
First Name:MARIKA
Middle Name:
Last Name:REESE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 E 38TH ST STE 220A
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55409-1455
Mailing Address - Country:US
Mailing Address - Phone:651-410-8148
Mailing Address - Fax:612-465-3420
Practice Address - Street 1:310 E 38TH ST STE 220A
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55409-1455
Practice Address - Country:US
Practice Address - Phone:651-410-8148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-04
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1-23-69783103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst