Provider Demographics
NPI:1205848553
Name:BOERSMA, BRIAN DAVID (MSW, LICSW)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:DAVID
Last Name:BOERSMA
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 W MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258-1321
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1212 E COLLEGE DR
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-2010
Practice Address - Country:US
Practice Address - Phone:507-532-3236
Practice Address - Fax:507-532-0240
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN111191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN62-71293OtherMEDICA
MN02G32BOOtherBLUE CROSS BLUE SHIELD
MNHP37849OtherHEALTH PARTNERS
MN114796OtherUCARE
MN2063868OtherUNITED HEALTHCARE
MN23267OtherSIOUX VALLEY HEALTH
MN1016406OtherPREFERRED ONE