MEDICARE: MRS. ANGIE GWIAZDON LMFT, MSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	1211	MN

General Provider Information

NPI Number	:	1982650214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGIE GWIAZDON LMFT, MSE

Provider Business Mailing Address
First Line	:	4284 DAHLBERG DR
Second Line	:
City	:	GOLDEN VALLEY
State	:	MN
Zip	:	55422-4805
Country	:	US
Telephone Number	:	952-428-6332
Fax Number	:	612-374-4498

Provider Business Practice Location Address
First Line	:	4284 DAHLBERG DR
Second Line	:
City	:	GOLDEN VALLEY
State	:	MN
Zip	:	55422-4805
Country	:	US
Telephone Number	:	952-428-6332
Fax Number	:	612-374-4498

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	06/25/2026

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