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General NPI Number Information
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NPI Number | 1275330649
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Entity Type | Individual
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Provider Name | BROOKE MARIE BERTRAM MSW, LICSW
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Gender | Female
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Dates
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Enumeration Date | 02/25/2025
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 1801 AMERICAN BLVD E STE 8
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City | BLOOMINGTON
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State | MN
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Zip | 55425-1230
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Country | US
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Telephone | 612-400-6153
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Fax |
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Provider Business Mailing Address
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Address Line | 1740 NORFOLK AVE APT 16
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City | SAINT PAUL
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State | MN
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Zip | 55116-3059
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Country | US
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Telephone | 651-332-9753
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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