Amanda Elizabeth Bolgren, MS, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

BA-23 Issued in HI

Practice address

1801 American Blvd E Ste 8
Bloomington, MN 55425-1230

Phone

(952) 767-2267

NPI assigned

Jan 22, 2009

Last updated

Mar 26, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Fraser Child and Family Center

  • Adolescent and Children Mental Health Clinic/Center
  • Minneapolis, MN
  • NPI 1609922194
  NPD
• Fraser

  • Rehabilitation Clinic/Center
  • Richfield, MN
  • NPI 1063568574
  NPD (past)
• Hale Kipa, Inc.

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Ewa Beach, HI
  • NPI 1164627246

  Mental Health

  NPD (past)

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

{
    "created_epoch": "1232582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616716800000",
    "number": "1891933230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16782 VON KARMAN AVE STE 11",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926062417",
            "telephone_number": "619-550-6368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 AMERICAN BLVD E STE 8",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554251230",
            "telephone_number": "952-767-2267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLGREN",
        "first_name": "AMANDA",
        "middle_name": "ELIZABETH",
        "credential": "MS, BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-01-22",
        "last_updated": "2021-03-26",
        "certification_date": "2021-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "HI",
            "license": "MH-272",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "MN",
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "HI",
            "license": "BA-23",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBA CERTIFICATE",
            "identifier": "1-15-19783",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Body Balance Golf & Physical Therapy, LLC (Body Balance for Performance)
• Bodyworks Physical Therapy Inc
• Deborah C Bohn, MD
• Natalie R Boland
• Bold North Beltone LLC
• Jermaine Montell Bolling
• Tryca D Bolling
• Elena Bond, M.D.
• Michael Bond, M.D.
• Cheslea Jo Bonk

• Behavior Analyst in Bloomington, MN
• Providers in Bloomington, MN by specialty
• Behavior Analyst in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2021; 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.