Martha Bordwell, PHD

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LP2322 Issued in MN

Practice address

5615 Brooklyn Blvd
Suite 105
Brooklyn Center, MN 55429-3000

Phone

(763) 531-0566

Fax

(763) 531-0602

NPI assigned

Nov 12, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• North Therapy and Wellness PA

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Champlin, MN
  • NPI 1265462212
  NPD (past)

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

{
    "created_epoch": "1163289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1220313600000",
    "number": "1821169962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5615 BROOKLYN BLVD",
            "address_2": "SUITE 105",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554293000",
            "telephone_number": "763-531-0566",
            "fax_number": "763-531-0602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5615 BROOKLYN BLVD",
            "address_2": "SUITE 105",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554293000",
            "telephone_number": "763-531-0566",
            "fax_number": "763-531-0602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORDWELL",
        "first_name": "MARTHA",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-12",
        "last_updated": "2008-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "LP2322",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSSBLUESHIELD",
            "identifier": "68831BO",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "993552500",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "61-20302",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "102392",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS",
            "identifier": "HP35967",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tiesa L Bogard
• Gammachis Bokku
• Akeya Bolden, LPCC, LADC
• Amy M Bonifas, MD
• Serena Bonorden
• Fatna Bougataia
• Boulevard Natural Healing Arts, PA
• Bourne Wellness Center LLC
• Jalaya Bouye
• Jennifer Sue Boyd, MA, LMFT

• Mental Health Counselor in Brooklyn Center, MN
• Providers in Brooklyn Center, MN by specialty
• Mental Health Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.