Healthcare Provider Details

I. General information

NPI: 1700602943
Provider Name (Legal Business Name): REBECCA BJORKLUND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 UNIVERSITY AVE W
SAINT PAUL MN
55103-1959
US

IV. Provider business mailing address

PO BOX 213
PINE CITY MN
55063-0213
US

V. Phone/Fax

Practice location:
  • Phone: 651-422-9317
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number304284
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: