Bruce Keith Thordal in Eagan - Cognitive & Behavioral
Bruce Keith Thordal - NPI 1417091455
Bruce Keith Thordal is a Cognitive & Behavioral in Eagan, Minnesota. Bruce Keith Thordal practices all healthcare services and medical treatments related to Cognitive & Behavioral. The NPI Number for Bruce Keith Thordal is 1417091455. The last update date is 2007-07-08.
Bruce Keith Thordal's current location address is 2870 Highview Ter, Eagan, Minnesota. You can contact this provider via phone number 6128601238 and fax number 9529481277. The mailing address for Bruce Keith Thordal is 2870 Highview Ter, Eagan, Minnesota. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Bruce Keith Thordal |
|---|---|
| Address | 2870 Highview Ter, Eagan, Minnesota |
| Phone Number | 6128601238 |
| Fax Number | 9529481277 |
| Sole Proprietor | Y |
| Credentials | PHD |
NPI Number Detail
| NPI Number | 1417091455 |
|---|---|
| Provider Enumeration Date | 2007-02-15 |
| Last Updated Date | 2007-07-08 |
Provider Mailing Address Detail
| Address | 2870 Highview Ter |
|---|---|
| City | Eagan |
| State | Minnesota (MN) |
| Post Code | 551211110 |
| Phone Number | 6128601238 |
| Fax Number | 9529481277 |
Provider's Primary Taxonomy Detail
| Speciality | Cognitive & Behavioral |
|---|---|
| Taxonomy | 103Tb0200X |
| Licence No | LP1135 |
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Definition: A psychologist who reflects an experimental-clinical approach distinguished by use of principles of human learning and development and theories of cognitive processing to promote meaningful change in maladaptive human behavior and thinking. |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 201747400 | MN | MEDICAL ASSISTANCE |
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What is the unique 10-digit identification code issued to Bruce Keith Thordal by the Centers for Medicare & Medicaid Services?
The Bruce Keith Thordal has been assigned the NPI (National Provider Identifier) 1417091455 by the Centers for Medicare & Medicaid Services (CMS). This 10-digit code serves as a unique identifier for healthcare providers.
Can you provide the Bruce Keith Thordal's physical address?
The Bruce Keith Thordal is physically located at 2870 Highview Ter, in the city of Eagan, MN, with the postal code 551211110.
What is Bruce Keith Thordal's area of expertise and its corresponding taxonomy classification?
The Bruce Keith Thordal's field of specialization is Cognitive & Behavioral, and it falls under the taxonomy code 103Tb0200X, which categorizes healthcare providers based on their areas of practice.
On what date did the Centers for Medicare & Medicaid Services assign the 1417091455 to Bruce Keith Thordal?
The Centers for Medicare & Medicaid Services assigned the 1417091455 to Bruce Keith Thordal on 2007-02-15.
As of what date were the Bruce Keith Thordal's details last updated?
The information pertaining to the Bruce Keith Thordal, including its address, specialty, and other details, was most recently updated on 2007-07-08.
NPI Number: 1215930425
Address: 224 W Exchange St, Akron, OH