Individual
DR. JODI RAE BOERGER WILDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LP
Contact information
Practice address
1245 WASHINGTON AVE, DETROIT LAKES, MN 56501-3905
(218) 846-2000
(218) 846-2114
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP4398
MN
103TC0700X
Clinical Psychologist
LP4398
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1032397
PREFERRED ONE
—
05
—
1699744227
—
MN
01
—
171126
UCARE ALTRU
MN
01
—
22522
BCBS OF ND
ND
01
—
310T1B0
BCBS BHST
MN
01
—
6159749
UBH MEDICA
MN
05
—
629899100
—
MN
01
—
HP37004
HEALTH PARTNERS
—
Enumeration date
03/16/2006
Last updated
03/08/2023
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