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NPI Code Detail

MEDICARE: BLUESTEM CENTER FOR CHILD AND FAMILY DEVELOPMENT, P.A.

MEDICARE: BLUESTEM CENTER FOR CHILD AND FAMILY DEVELOPMENT, P.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1003868167
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLUESTEM CENTER FOR CHILD AND FAMILY DEVELOPMENT, P.A.
Provider Business Mailing Address
First Line : 124 ELTON HILLS LN NW
Second Line :
City : ROCHESTER
State : MN
Zip : 55901-3577
Country : US
Telephone Number : 507-282-1009
Fax Number :
Provider Business Practice Location Address
First Line : 124 ELTON HILLS LN NW
Second Line :
City : ROCHESTER
State : MN
Zip : 55901-3577
Country : US
Telephone Number : 507-282-1009
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : SUSAN C JENKINS
Credential : MD
Telephone Number : 507-282-1009
Provider Enumeration Date : 05/17/2006
Last Update Date : 09/16/2014

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