Individual
MR. JOEL T BAKKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS LP
Contact information
Practice address
1547 30TH AVE S, MOORHEAD, MN 56560-5149
(218) 287-4338
(218) 287-5928
Mailing address
1547 30TH AVE S, MOORHEAD, MN 56560-5149
(218) 287-4338
(218) 287-5928
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP0872
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
140L6BA
BLUE CROSS
MN
05
—
448852100
—
MN
Enumeration date
10/03/2006
Last updated
05/15/2024
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