Healthcare Provider Details

I. General information

NPI: 1558458562
Provider Name (Legal Business Name): DUANE CLEABERT BJERKE MA, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 89TH AVE NE SUITE 390
BLAINE MN
55434-3370
US

IV. Provider business mailing address

11720 BRUNSWICK AVE N
CHAMPLIN MN
55316-2485
US

V. Phone/Fax

Practice location:
  • Phone: 612-879-5361
  • Fax:
Mailing address:
  • Phone: 763-323-3375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1119
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: