Provider Demographics
NPI:1508962960
Name:BREKKE, DENNIS M (PHD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:M
Last Name:BREKKE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10331 108TH PL N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-2638
Mailing Address - Country:US
Mailing Address - Phone:763-424-4439
Mailing Address - Fax:
Practice Address - Street 1:2021 E HENNEPIN AVE
Practice Address - Street 2:SUITE 411
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1896
Practice Address - Country:US
Practice Address - Phone:612-991-1769
Practice Address - Fax:612-395-5585
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1738103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN546347500Medicaid
MN01992BROtherBCBS PROVIDER NUMBER
MN1H217BROtherBCBS PROVIDER NUMBER