Provider Demographics
NPI:1083323455
Name:BORST, BROOKE LYNN (LGSW)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:LYNN
Last Name:BORST
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:LYNN
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LGSW
Mailing Address - Street 1:2343 OLYMPIC ST
Mailing Address - Street 2:
Mailing Address - City:BROOK PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55007-4626
Mailing Address - Country:US
Mailing Address - Phone:651-402-3211
Mailing Address - Fax:
Practice Address - Street 1:2343 OLYMPIC ST
Practice Address - Street 2:
Practice Address - City:BROOK PARK
Practice Address - State:MN
Practice Address - Zip Code:55007-4626
Practice Address - Country:US
Practice Address - Phone:651-402-3211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-15
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN310081041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty