Bourdo, Dennis R
Bourdo, Dennis R is an individual health care provider with primary practice located at 1540 Trinity Pl , Mishawaka IN 46545-5006. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Bourdo, Dennis R can be contacted via phone (574) 272-9000.Contact Information
Primary practice address
1540 Trinity Pl
Mishawaka IN 46545-5006
Phone: (574) 272-9000
Fax: (574) 272-9299
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | 6301013489 | Michigan |
Profile Details
| NPI number | 1861549792 |
|---|---|
| LBN Legal business name | Bourdo, Dennis R |
| Credentials | PSYD |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 4th, 2007 |
| Last updated | Jan 31st, 2022 - about 2 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1861549792 | NPPES |
| Michigan | Other | 205814984 | TAX IDENTIFICATION |
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