Provider Demographics
NPI:1134450083
Name:BOROWIAK, MICHAEL ROBERT (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROBERT
Last Name:BOROWIAK
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:11812 WAYZATA BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-2012
Mailing Address - Country:US
Mailing Address - Phone:952-922-8822
Mailing Address - Fax:952-922-7222
Practice Address - Street 1:11812 WAYZATA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-2012
Practice Address - Country:US
Practice Address - Phone:952-922-8822
Practice Address - Fax:952-922-7222
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN136271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical