Bodurtha, Heather

Bodurtha, Heather is an individual health care provider with primary practice located at 1900 Silver Lake Rd Nw 110, New Brighton MN 55112-1786. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Bodurtha, Heather can be contacted via phone (651) 628-9566.

Contact Information

Primary practice address
1900 Silver Lake Rd Nw 110 New Brighton MN 55112-1786
Phone: (651) 628-9566
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X LP4705 Minnesota

Profile Details

NPI number 1679774673
LBN Legal business name Bodurtha, Heather
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date May 29th, 2007
Last updated Oct 10th, 2012 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1679774673 NPPES
Minnesota MEDICAID 652660100

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