Provider Demographics
NPI:1760439624
Name:TORKILDSON, JAMES J (EDD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:TORKILDSON
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9241 280TH ST S
Mailing Address - Street 2:
Mailing Address - City:HAWLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56549-8985
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 HIGHWAY 34 E
Practice Address - Street 2:SUITE A104
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-2643
Practice Address - Country:US
Practice Address - Phone:218-331-8026
Practice Address - Fax:218-937-5657
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4518103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNPENDINGOtherPREFERREDONE
MNPENDINGOtherUNITED BEHAVIORAL HEALTH
MNPENDINGOtherUCARE MINNESOTA
MNPENDINGOtherHEALTHPARTNERS
MNPENDINGOtherBLUE SHIELD OF MINNESOTA
MNPENDINGMedicaid
MNPENDINGMedicare ID - Type Unspecified