Provider Demographics
NPI:1194239095
Name:BJERKAAS, CINDY JOANN (LADC)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:JOANN
Last Name:BJERKAAS
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-1813
Mailing Address - Country:US
Mailing Address - Phone:320-763-0124
Mailing Address - Fax:320-763-0126
Practice Address - Street 1:909 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-1813
Practice Address - Country:US
Practice Address - Phone:320-763-0124
Practice Address - Fax:320-763-0126
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304965101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)