Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Laecretia Anisa Moallim

Individual provider Behavior Analyst · NPI 1053098723

Laecretia Anisa Moallim is a Behavior Analyst in Minneapolis, Minnesota. Registered with an NPI since 2023.

In the registry since
2023

Practice location Address checks out

1600 Broadway St NE # 250
Minneapolis, MN 55413-2617
Phone: (952) 303-5803
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Behavior Analyst (primary) Taxonomy 103K00000X

Record details

NPI number1053098723
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedJuly 3, 2023
Last updated in NPPESJuly 3, 2023
Certification dateJuly 3, 2023

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