Provider Demographics
NPI:1720358286
Name:BOHLINGER, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:BOHLINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1772 STIEGER LAKE LN.
Mailing Address - Street 2:P.O. BOX 51
Mailing Address - City:VICTORIA
Mailing Address - State:MN
Mailing Address - Zip Code:55386
Mailing Address - Country:US
Mailing Address - Phone:952-443-4600
Mailing Address - Fax:
Practice Address - Street 1:12915 63RD AVE N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-6001
Practice Address - Country:US
Practice Address - Phone:952-826-8400
Practice Address - Fax:952-383-5802
Is Sole Proprietor?:No
Enumeration Date:2011-12-30
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MN2514106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health