Individual
DR. MARY RUTH BOEHLKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
1660 HIGHWAY 100 S, STE. 568, MINNEAPOLIS, MN 55416-1529
(952) 545-6800
Mailing address
17935 2ND AVE N, PLYMOUTH, MN 55447-3486
(763) 476-4924
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
MN LP0708
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1G186BO
BLUE CROSS OF MN
MN
Enumeration date
01/14/2006
Last updated
07/10/2007
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