Healthcare Provider Details

I. General information

NPI: 1396675203
Provider Name (Legal Business Name): ERIKKA BORCK MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1068 LAKE ST S STE 100
FOREST LAKE MN
55025-2633
US

IV. Provider business mailing address

408 12TH AVE SE
FOREST LAKE MN
55025-1915
US

V. Phone/Fax

Practice location:
  • Phone: 651-982-4792
  • Fax:
Mailing address:
  • Phone: 651-403-0102
  • Fax: 651-403-0102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: