Healthcare Provider Details

I. General information

NPI: 1194239095
Provider Name (Legal Business Name): CINDY JOANN BJERKAAS LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 BROADWAY ST
ALEXANDRIA MN
56308-1813
US

IV. Provider business mailing address

909 BROADWAY ST
ALEXANDRIA MN
56308-1813
US

V. Phone/Fax

Practice location:
  • Phone: 320-763-0124
  • Fax: 320-763-0126
Mailing address:
  • Phone: 320-763-0124
  • Fax: 320-763-0126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number304965
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: