Individual
AMANDA ELIZABETH BOLGREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, BCBA
Contact information
Practice address
1801 AMERICAN BLVD E STE 8, BLOOMINGTON, MN 55425-1230
(952) 767-2267
Mailing address
16782 VON KARMAN AVE STE 11, IRVINE, CA 92606-2417
(619) 550-6368
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
MH-272
HI
103K00000X
Behavior Analyst
Primary
BA-23
HI
103K00000X
Behavior Analyst
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-15-19783
BCBA CERTIFICATE
—
Enumeration date
01/22/2009
Last updated
03/26/2021
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