Individual
DR. BRUCE LEE BAKKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
3300 COUNTY ROAD 10, SUITE 500, BROOKLYN CENTER, MN 55429-3072
(763) 560-8331
(763) 560-8431
Mailing address
2012 IGLEHART AVE, SAINT PAUL, MN 55104-5146
(651) 645-3949
(651) 645-3949
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP2204
MN
103TA0700X
Adult Development & Aging Psychologist
LP2204
MN
103TB0200X
Cognitive & Behavioral Psychologist
LP2204
MN
103TM1800X
Intellectual & Developmental Disabilities Psychologist
LP2204
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
866750100
—
MN
Enumeration date
02/14/2007
Last updated
06/22/2010
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