Healthcare Provider Details

I. General information

NPI: 1326970070
Provider Name (Legal Business Name): GREGORY STUDELSKA III ED.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 ADAIR AVE N
CRYSTAL MN
55422-1944
US

IV. Provider business mailing address

3915 ADAIR AVE N
CRYSTAL MN
55422-1944
US

V. Phone/Fax

Practice location:
  • Phone: 763-504-8000
  • Fax:
Mailing address:
  • Phone: 763-504-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number2208785
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: