Individual
DR. DENNIS R BOURDO II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
1540 TRINITY PL, MISHAWAKA, IN 46545-5006
(574) 272-9000
(574) 272-9299
Mailing address
1540 TRINITY PL, MISHAWAKA, IN 46545-5006
(574) 272-9000
(574) 272-9299
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301013489
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
205814984
TAX IDENTIFICATION
MI
Enumeration date
01/04/2007
Last updated
09/12/2025
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