Provider Demographics
NPI:1295432532
Name:BODIN, KAREN A
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:BODIN
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 1:501 THEODORE WIRTH PKWY APT 109
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-5339
Mailing Address - Country:US
Mailing Address - Phone:651-263-1971
Mailing Address - Fax:
Practice Address - Street 1:501 THEODORE WIRTH PKWY APT 109
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-5339
Practice Address - Country:US
Practice Address - Phone:651-263-1971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator