Individual
MCKENZIE BOMSTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LICSW
Contact information
Practice address
411 3RD ST N, WAITE PARK, MN 56387-1177
(320) 253-4120
Mailing address
12017 62ND ST NE, SPICER, MN 56288-9440
(320) 266-5075
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
30958
MN
Other
Enumeration date
05/13/2019
Last updated
12/06/2024
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