Provider Demographics
NPI:1609669605
Name:BODEAU, ZACHARY (LPCC, MA)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:BODEAU
Suffix:
Gender:M
Credentials:LPCC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 W BROADWAY AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411-2469
Mailing Address - Country:US
Mailing Address - Phone:612-287-1600
Mailing Address - Fax:612-287-1616
Practice Address - Street 1:822 S 3RD ST STE 100
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1200
Practice Address - Country:US
Practice Address - Phone:612-217-1667
Practice Address - Fax:612-324-1864
Is Sole Proprietor?:No
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4891101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional