Provider Demographics
NPI:1720964489
Name:HANSPARD, ANTON TAVARES JR
Entity type:Individual
Prefix:
First Name:ANTON
Middle Name:TAVARES
Last Name:HANSPARD
Suffix:JR
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 1:3421 53RD AVE N APT 201
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-3436
Mailing Address - Country:US
Mailing Address - Phone:612-518-9302
Mailing Address - Fax:
Practice Address - Street 1:2812 FAIRVIEW AVE N
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1308
Practice Address - Country:US
Practice Address - Phone:651-383-1048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician