Individual
MICHAEL D BROADWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D
Contact information
Practice address
3535 40TH AVE NW STE 210, ROCHESTER, MN 55901-1769
(507) 516-0227
(507) 516-0228
Mailing address
3535 40TH AVE NW STE 210, ROCHESTER, MN 55901-1769
(507) 516-0227
(507) 516-0228
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
103K00000X
Behavior Analyst
—
—
103T00000X
Psychologist
Primary
LP6869
MN
103T00000X
Psychologist
—
—
Other
Enumeration date
09/22/2009
Last updated
12/12/2022
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