Provider Demographics
NPI:1265075162
Name:BRODINE, ANGELA EMILY (MS)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:EMILY
Last Name:BRODINE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 HYLAND GREENS DR APT 702
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437-3909
Mailing Address - Country:US
Mailing Address - Phone:612-231-1197
Mailing Address - Fax:
Practice Address - Street 1:5301 HYLAND GREENS DR APT 702
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55437-3909
Practice Address - Country:US
Practice Address - Phone:612-231-1197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional