Provider Demographics
NPI:1790089878
Name:BOLOGNA, NANCY CLAIRE (PHD, MS, LP)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:CLAIRE
Last Name:BOLOGNA
Suffix:
Gender:F
Credentials:PHD, MS, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7525 MITCHELL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-1959
Mailing Address - Country:US
Mailing Address - Phone:612-360-8305
Mailing Address - Fax:
Practice Address - Street 1:7525 MITCHELL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-1959
Practice Address - Country:US
Practice Address - Phone:612-360-8305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1470103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical