Healthcare Provider Details

I. General information

NPI: 1538031919
Provider Name (Legal Business Name): ASHA GOUDE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 10/24/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 E 78TH ST
MINNEAPOLIS MN
55420-1400
US

IV. Provider business mailing address

1101 E 78TH ST
MINNEAPOLIS MN
55420-1400
US

V. Phone/Fax

Practice location:
  • Phone: 952-854-5034
  • Fax:
Mailing address:
  • Phone: 952-854-5034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: