Provider Demographics
NPI:1083323455
Name:BORST, BROOKE LYNN (LGSW)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:LYNN
Last Name:BORST
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:LYNN
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LGSW
Mailing Address - Street 1:2343 OLYMPIC ST
Mailing Address - Street 2:
Mailing Address - City:BROOK PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55007-4626
Mailing Address - Country:US
Mailing Address - Phone:651-402-3211
Mailing Address - Fax:
Practice Address - Street 1:501 MAIN ST
Practice Address - Street 2:
Practice Address - City:SANDSTONE
Practice Address - State:MN
Practice Address - Zip Code:55072-4410
Practice Address - Country:US
Practice Address - Phone:320-372-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN31008104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker