DR. BRUCE KEITH THORDAL PHD NPI 1417091455

NPI Information

  • NPI: 1417091455
  • Provider Name: DR. BRUCE KEITH THORDAL, PHD
  • Classification: Psychologist - 103TB0200X
  • Specialization: Cognitive & Behavioral
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 2870 HIGHVIEW TER
    EAGAN, MN
    ZIP 55121
  • Phone: (612) 860-1238

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NPI Details

DR. Bruce Keith Thordal, PHD is a cognitive and behavioral psychologist in Eagan, MN with 51 years of experience. The provider is a psychologist who reflects an experimental-clinical approach distinguished by use of principles of human learning and development and theories of cognitive processing to promote meaningful change in maladaptive human behavior and thinking. DR. Bruce Keith Thordal, PHD NPI is 1417091455. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

2870 HIGHVIEW TER
EAGAN, MN
ZIP 55121-110
Phone: (612) 860-1238
Fax: (952) 948-1277

The NPI 1417091455 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Psychiatric services complicated by communication factor (HCPCS:90785)
  • Psychotherapy, 1 hour (HCPCS:90837)

The enumeration date for this NPI number is 2/15/2007 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1103TB0200XPsychologistCognitive & BehavioralLP1135MINNESOTAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1201747400OTHERMINNESOTAMEDICAL ASSISTANCE
2680000676MEDICARE ID-TYPE UNSPECIFIEDMINNESOTA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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