Provider Demographics
NPI:1700595741
Name:BJERK, KACIE MARIE
Entity type:Individual
Prefix:MS
First Name:KACIE
Middle Name:MARIE
Last Name:BJERK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 7TH ST SW
Mailing Address - Street 2:
Mailing Address - City:ROSEAU
Mailing Address - State:MN
Mailing Address - Zip Code:56751-1478
Mailing Address - Country:US
Mailing Address - Phone:218-469-1210
Mailing Address - Fax:
Practice Address - Street 1:2900 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:CROOKSTON
Practice Address - State:MN
Practice Address - Zip Code:56716-5000
Practice Address - Country:US
Practice Address - Phone:218-281-8427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-17
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN37252255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer