Provider Demographics
NPI:1114012697
Name:BJORNSON, GLEN STAFFAN (MA, LP)
Entity Type:Individual
Prefix:
First Name:GLEN
Middle Name:STAFFAN
Last Name:BJORNSON
Suffix:
Gender:M
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 1:350 ARCWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MAHTOMEDI
Mailing Address - State:MN
Mailing Address - Zip Code:55115-1833
Mailing Address - Country:US
Mailing Address - Phone:651-777-8161
Mailing Address - Fax:
Practice Address - Street 1:7616 CURRELL BLVD
Practice Address - Street 2:SUITE 290
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2290
Practice Address - Country:US
Practice Address - Phone:651-730-7525
Practice Address - Fax:651-769-6599
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2995103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling