Provider Demographics
NPI:1972103224
Name:NIELSEN, BOBBI
Entity type:Individual
Prefix:
First Name:BOBBI
Middle Name:
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1470 INDUSTRIAL DR NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-0700
Mailing Address - Country:US
Mailing Address - Phone:507-322-7751
Mailing Address - Fax:
Practice Address - Street 1:33854 630TH AVE
Practice Address - Street 2:
Practice Address - City:SARGEANT
Practice Address - State:MN
Practice Address - Zip Code:55973-8539
Practice Address - Country:US
Practice Address - Phone:507-272-5674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician