Healthcare Provider Details

I. General information

NPI: 1780660951
Provider Name (Legal Business Name): MAIDA G GUNTHER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 MINNESOTA DR STE 200
BLOOMINGTON MN
55435-5202
US

IV. Provider business mailing address

3601 MINNESOTA DR STE 200
BLOOMINGTON MN
55435-5202
US

V. Phone/Fax

Practice location:
  • Phone: 612-879-1000
  • Fax: 612-879-9116
Mailing address:
  • Phone: 612-879-1000
  • Fax: 612-879-9116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP3565
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP3565
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberLP3565
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: