Provider Demographics
NPI:1336232347
Name:BJORNSTAD, LEE
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:BJORNSTAD
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:PO BOX 688
Mailing Address - Street 2:
Mailing Address - City:CANDO
Mailing Address - State:ND
Mailing Address - Zip Code:58324-0688
Mailing Address - Country:US
Mailing Address - Phone:701-968-2554
Mailing Address - Fax:701-968-2574
Practice Address - Street 1:7448 68TH AVE NE
Practice Address - Street 2:
Practice Address - City:CANDO
Practice Address - State:ND
Practice Address - Zip Code:58324-9485
Practice Address - Country:US
Practice Address - Phone:701-968-2568
Practice Address - Fax:701-968-2552
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1529101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND27224OtherBCBS PROVIDER #
ND27225OtherBCBS PROVIDER #