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General NPI Number Information
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NPI Number | 1609669605
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Entity Type | Individual
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Provider Name | ZACHARY BODEAU LPCC, MA
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Gender | Male
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Dates
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Enumeration Date | 05/23/2025
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 822 S 3RD ST STE 100
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City | MINNEAPOLIS
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State | MN
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Zip | 55415-1200
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Country | US
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Telephone | 612-217-1667
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Fax | 612-324-1864
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Provider Business Mailing Address
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Address Line | 1931 W BROADWAY AVE STE 101
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City | MINNEAPOLIS
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State | MN
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Zip | 55411-2469
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Country | US
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Telephone | 612-287-1600
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Fax | 612-287-1616
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4891
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License Number State | MN
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