Connor Bolduc

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

4468 Issued in MN

Practice address

2103 County Road D E Ste B
Maplewood, MN 55109-5358

Phone

(612) 915-0049

NPI assigned

Feb 16, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Family Innovations, Inc.

  • Counseling Psychologist
  • Anoka, MN
  • NPI 1992862783

  Professional

  Medicare reassignment NPD
• The College Therapy Center

  • Student Health Clinic/Center
  • Saint Paul, MN
  • NPI 1841945052
  NPD (past)
• West Central Counseling LLC

  • Mental Health Counselor
  • Alexandria, MN
  • NPI 1649846650
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1644969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753660800000",
    "number": "1093460180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 N SCOTTSDALE RD STE 2500",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852517630",
            "telephone_number": "612-915-0049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2103 COUNTY ROAD D E STE B",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551095358",
            "telephone_number": "612-915-0049"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "239 Cleveland Ave N",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551045730",
            "country_code": "US",
            "telephone_number": "612-712-6435",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOLDUC",
        "first_name": "CONNOR",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-02-16",
        "last_updated": "2025-07-28",
        "certification_date": "2025-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "4468",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blue Jay Family Dentistry PLLC
• Kofi Boadu-Mensah
• Adaline Boden, OTR/L
• Amanda Boettger, PA-C
• Bold Steps Therapy & Support Inc
• Vanessa Bonjour, PA-C
• Pilar Boril, FNP-C
• Ernest Boswell, PH.D.
• Michelle Jeanne Botko, M.A.
• Karna Elizabeth Boynton, MA, LMFT

• Professional Counselor in Maplewood, MN
• Providers in Maplewood, MN by specialty
• Professional Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.