Healthcare Provider Details

I. General information

NPI: 1427706019
Provider Name (Legal Business Name): ROSS BOEKHOFF
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 78TH AVE N
BROOKLYN PARK MN
55445-2719
US

IV. Provider business mailing address

101 W 2ND ST
DULUTH MN
55802-2086
US

V. Phone/Fax

Practice location:
  • Phone: 763-432-6875
  • Fax: 833-933-0639
Mailing address:
  • Phone: 218-724-3122
  • Fax: 833-933-0639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: