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Contact Information

BRYAN A BLOEMENDAAL, MS, LAC
4215 9TH AVE S
FARGO, ND58103-2018
 Phone: 701-373-8667
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Addiction (Substance Use Disorder)

101YA0400X
Indicates primary specialty

NPI Profile & details for BRYAN A BLOEMENDAAL · (Male)

NPI # 1245784156
Status Active
Credentials MS, LAC
Entity Individual
Enumeration date 08/09/2016
Last updated 08/29/2016 - About 10 years ago
Sole proprietor 1 Yes
Identifiers
  • MN License # 304586
  • ND License # 1797
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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