Healthcare Provider Details

I. General information

NPI: 1124394721
Provider Name (Legal Business Name): TAWNDA BICKFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8120 PENN AVE S STE 400
BLOOMINGTON MN
55431-1311
US

IV. Provider business mailing address

16826 TRENTON LN
EDEN PRAIRIE MN
55347-3376
US

V. Phone/Fax

Practice location:
  • Phone: 800-693-1916
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberLP5071
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP5071
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: