Doctor Name: | MR. TODD BORSTAD |
NPI Number: | 1033353669 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LICSW |
License Number: | 17389 |
Business Practice Address: | 3450 O'leary Lane Eagan, MN - 55123 |
Business Phone Number: | 6514540114 |
Business Fax Number: | 6514543492 |
Mailing Address: | 3450 Oleary Ln, EAGAN |
State: | MN |
Postal Code: | 551232340 |
Phone Number: | 6514540114 |
Fax Number: | 6514549492 |
NPI Enumeration Date: | 04/27/2009 |
NPI Last Update Date: | 04/27/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 17389 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |