Provider Demographics
NPI:1508116492
Name:BIRKLAND, JOHN ALBERT IV (MA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ALBERT
Last Name:BIRKLAND
Suffix:IV
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 LAUREL AVE
Mailing Address - Street 2:APT #6
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-4800
Mailing Address - Country:US
Mailing Address - Phone:319-573-5387
Mailing Address - Fax:
Practice Address - Street 1:2345 ARIEL STREET NORTH
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-2248
Practice Address - Country:US
Practice Address - Phone:651-254-4793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2372106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist