Doctor Name: | MELISSA BROGGER |
NPI Number: | 1972738920 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA LADC |
License Number: | 300082 |
Business Practice Address: | 1000 Paul Pkwy Ne Blaine, MN - 554343925 |
Business Phone Number: | 7637572906 |
Business Fax Number: | 7637572059 |
Mailing Address: | 115 Forestview Ln N, PLYMOUTH |
State: | MN |
Postal Code: | 554415910 |
Phone Number: | 7635429212 |
Fax Number: | 7635429248 |
NPI Enumeration Date: | 05/20/2009 |
NPI Last Update Date: | 05/20/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | 300082 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |