Individual
MR. MARK C BORDEWICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD LP
Contact information
Practice address
1321 13TH ST N, ST CLOUD, MN 56303-2614
(320) 252-5010
(320) 203-1855
Mailing address
1321 13TH ST N, ST CLOUD, MN 56303-2614
(320) 252-5010
(320) 203-1855
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP0984
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03Q37B0
BCBS
—
05
—
095248600
—
MN
01
—
117014C851
UCARE
—
01
—
44544
OPTUM
—
01
—
6100032
MEDICA
—
01
—
922241012150
PREFERRED ONE
—
01
—
HP25562
HEALTH PARTNERS
—
Enumeration date
06/15/2006
Last updated
01/27/2010
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