Provider Demographics
NPI:1811615107
Name:TORKILDSON, AJA
Entity type:Individual
Prefix:
First Name:AJA
Middle Name:
Last Name:TORKILDSON
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 1:2001 BRYANT AVE S APT 214
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405-2826
Mailing Address - Country:US
Mailing Address - Phone:651-308-9269
Mailing Address - Fax:
Practice Address - Street 1:1404 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1517
Practice Address - Country:US
Practice Address - Phone:612-789-8030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)