| Doctor Name: | DR. BRUCE LEE BAKKE |
| NPI Number: | 1184767675 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | LP2204 |
| Business Practice Address: | 3300 County Road 10 Suite 500 Brooklyn Center, MN - 554293072 |
| Business Phone Number: | 7635608331 |
| Business Fax Number: | 7635608431 |
| Mailing Address: | 2012 Iglehart Ave, SAINT PAUL |
| State: | MN |
| Postal Code: | 551045146 |
| Phone Number: | 6516453949 |
| Fax Number: | 6516453949 |
| NPI Enumeration Date: | 02/14/2007 |
| NPI Last Update Date: | 06/22/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TA0700X |
| License Number: | LP2204 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Adult Development & Aging |
| Taxonomy Definition: | |