Provider Demographics
NPI:1992481139
Name:BEARG, JOHN MICHAEL PATRICK
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MICHAEL PATRICK
Last Name:BEARG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19115 RUTLEDGE RD
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-3052
Mailing Address - Country:US
Mailing Address - Phone:651-356-9591
Mailing Address - Fax:
Practice Address - Street 1:19115 RUTLEDGE RD
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-3052
Practice Address - Country:US
Practice Address - Phone:651-356-9591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician