Healthcare Provider Details

I. General information

NPI: 1215124011
Provider Name (Legal Business Name): MARIE-GABRIELLE J REED PHD, LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 NICOLLET AVE
MINNEAPOLIS MN
55403-3745
US

IV. Provider business mailing address

MEDICAL ARTS BUILDING 825 NICOLLET MALL, SUITE 411
MINNEAPOLIS MN
55402-3745
US

V. Phone/Fax

Practice location:
  • Phone: 612-596-0900
  • Fax: 612-879-3822
Mailing address:
  • Phone: 612-339-1736
  • Fax: 612-338-3169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberLP4835
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberLP4835
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP4835
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: