Individual
DR. BRUCE KEITH THORDAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
2870 HIGHVIEW TER, EAGAN, MN 55121-1110
(612) 860-1238
(952) 948-1277
Mailing address
2870 HIGHVIEW TER, EAGAN, MN 55121-1110
(612) 860-1238
(952) 948-1277
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
LP1135
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201747400
MEDICAL ASSISTANCE
MN
Enumeration date
02/15/2007
Last updated
07/08/2007
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