Provider Demographics
NPI:1003984931
Name:BOFENKAMP, BARBARA ANNE (MA LP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANNE
Last Name:BOFENKAMP
Suffix:
Gender:F
Credentials:MA LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CENTER FOR HUMAN RESOURCES INC
Mailing Address - Street 2:220 DIVISION ST
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057
Mailing Address - Country:US
Mailing Address - Phone:507-645-9304
Mailing Address - Fax:507-645-6151
Practice Address - Street 1:220 DIVISION ST
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057
Practice Address - Country:US
Practice Address - Phone:507-645-9304
Practice Address - Fax:507-645-6151
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0118103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
6220341OtherUBH
HP20450OtherHEALTH PARTNERS
MN9H002B0OtherBLUE CROSS BLUE SHIELD
797221025211OtherPREFERRED ONE