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General NPI Number Information
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NPI Number | 1457986556
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Entity Type | Individual
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Provider Name | JON BROOKSON ENGFER MPS LADC CPRS
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Gender | Male
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Dates
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Enumeration Date | 03/09/2020
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Last Update Date | 03/09/2020
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Provider Practice Location Address
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Address Line | 8609 LYNDALE AVENUE SOUTH
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City | BLOOMINGTON
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State | MN
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Zip | 55420
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Country | US
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Telephone | 952-358-1009
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Fax | 612-424-0906
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Provider Business Mailing Address
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Address Line | 809 SOUTHCROSS DRIVE EAST
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City | BRUNSVILLE
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State | MN
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Zip | 55306
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Country | US
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Telephone | 612-443-0142
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 305576
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License Number State | MN
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