Healthcare Provider Details

I. General information

NPI: 1477375632
Provider Name (Legal Business Name): MELISSA GAIL BJORK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7237 FORESTVIEW LN N
MAPLE GROVE MN
55369-5501
US

IV. Provider business mailing address

4860 MASON AVE NE
SAINT MICHAEL MN
55376-1072
US

V. Phone/Fax

Practice location:
  • Phone: 763-420-8595
  • Fax:
Mailing address:
  • Phone: 734-891-2160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2024-116
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: