Healthcare Provider Details

I. General information

NPI: 1083323455
Provider Name (Legal Business Name): BROOKE LYNN BORST LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BROOKE LYNN JAMES LGSW

II. Dates (important events)

Enumeration Date: 11/15/2022
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2343 OLYMPIC ST
BROOK PARK MN
55007-4626
US

IV. Provider business mailing address

2343 OLYMPIC ST
BROOK PARK MN
55007-4626
US

V. Phone/Fax

Practice location:
  • Phone: 651-402-3211
  • Fax:
Mailing address:
  • Phone: 651-402-3211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number31008
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number31008
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: