Provider Demographics
NPI:1487020160
Name:TOKKESDAL, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:TOKKESDAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 SILVER LAKE RD NW
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-1786
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1702 MILLER TRUNK HWY STE 209
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-4448
Practice Address - Country:US
Practice Address - Phone:218-524-8889
Practice Address - Fax:218-524-8890
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health