Individual
MARTHA BORDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
5615 BROOKLYN BLVD, SUITE 105, BROOKLYN CENTER, MN 55429-3000
(763) 531-0566
(763) 531-0602
Mailing address
5615 BROOKLYN BLVD, SUITE 105, BROOKLYN CENTER, MN 55429-3000
(763) 531-0566
(763) 531-0602
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LP2322
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102392
UCARE
MN
01
—
61-20302
MEDICA
MN
01
—
68831BO
BLUECROSSBLUESHIELD
MN
05
—
993552500
—
MN
01
—
HP35967
HEALTHPARTNERS
MN
Enumeration date
11/12/2006
Last updated
09/02/2008
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