Provider Demographics
NPI:1871374546
Name:FLEIGLE, DYLAN CHRISTINE
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:CHRISTINE
Last Name:FLEIGLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3924 CEDAR GROVE PKWY APT 104
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-1429
Mailing Address - Country:US
Mailing Address - Phone:651-206-7104
Mailing Address - Fax:
Practice Address - Street 1:1160 CENTRE POINTE DR STE 7
Practice Address - Street 2:
Practice Address - City:MENDOTA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55120-1377
Practice Address - Country:US
Practice Address - Phone:952-401-9359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician