Healthcare Provider Details

I. General information

NPI: 1114732104
Provider Name (Legal Business Name): LUKE WILLIAM BORKENHAGEN MSW, LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2025
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 MAPLE ST
BRAINERD MN
56401-3770
US

IV. Provider business mailing address

3505 E 26TH ST
MINNEAPOLIS MN
55406-1728
US

V. Phone/Fax

Practice location:
  • Phone: 218-454-3826
  • Fax: 218-454-1024
Mailing address:
  • Phone: 612-388-1673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number28986
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number28986
License Number StateMN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: