Individual
JESSICA BORDENAVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD, LP
Contact information
Practice address
1101 E 78TH ST STE 100, BLOOMINGTON, MN 55420-1402
(952) 854-5034
(952) 854-5363
Mailing address
1900 SILVER LAKE RD NW STE 110, NEW BRIGHTON, MN 55112-1789
(651) 628-9566
(651) 628-0411
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
3557-57
WI
103TC0700X
Clinical Psychologist
Primary
6325
MN
Other
Enumeration date
06/04/2018
Last updated
11/12/2018
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