Healthcare Provider Details

I. General information

NPI: 1033025044
Provider Name (Legal Business Name): DANA MARIE BOECKERS ADC-T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 E MAIN ST
PERHAM MN
56573-1934
US

IV. Provider business mailing address

840 E MAIN ST
PERHAM MN
56573-1934
US

V. Phone/Fax

Practice location:
  • Phone: 218-346-6100
  • Fax: 218-249-1507
Mailing address:
  • Phone: 218-346-6100
  • Fax: 218-249-1507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: