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NPI Code Detail

MEDICARE: BARBARA JEAN TOLLEFSON MA LP

MEDICARE: BARBARA JEAN TOLLEFSON MA LP
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
1103TC0700XClinical PsychologistLP2285MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1333J5TOOTHERMNINDIV BCBS NUMBER
26234967OTHERMNUBH
3333J4TOOTHERMNBCBS
4110707OTHERMNUCARE

General Provider Information

NPI Number : 1538236039
Entity Type Code : Individual
Provider Name (Legal Business Name) : BARBARA JEAN TOLLEFSON MA LP
Provider Business Mailing Address
First Line : PO BOX 546
Second Line : 261 E BROADWAY
City : MONTICELLO
State : MN
Zip : 55362-0546
Country : US
Telephone Number : 763-295-3207
Fax Number : 763-295-6666
Provider Business Practice Location Address
First Line : 261 E BROADWAY ST
Second Line :
City : MONTICELLO
State : MN
Zip : 55362-9317
Country : US
Telephone Number : 763-295-3207
Fax Number : 763-295-6666
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2006
Last Update Date : 07/08/2007

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