Healthcare Provider Details

I. General information

NPI: 1366299133
Provider Name (Legal Business Name): STEVEN BJORN BJELLAND LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2024
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2237 3RD ST E
SAINT PAUL MN
55119-4026
US

IV. Provider business mailing address

2237 3RD ST E
SAINT PAUL MN
55119-4026
US

V. Phone/Fax

Practice location:
  • Phone: 218-340-6975
  • Fax:
Mailing address:
  • Phone: 218-340-6975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number25101
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: