1265084735 NPI number — DENISE BLOCZYNSKI RODILES MA, LMFT

Table of content: DENISE BLOCZYNSKI RODILES MA, LMFT (NPI 1265084735)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265084735 NPI number — DENISE BLOCZYNSKI RODILES MA, LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODILES
Provider First Name:
DENISE
Provider Middle Name:
BLOCZYNSKI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265084735
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9400 ZANE AVE N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN PARK
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55443-1814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-762-8800
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 BEAM AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAPLEWOOD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55109-1401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-737-4500
Provider Business Practice Location Address Fax Number:
651-209-0514
Provider Enumeration Date:
07/15/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  3659 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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