Healthcare Provider Details

I. General information

NPI: 1285395707
Provider Name (Legal Business Name): GLORINA SAUCEDO FRUETEL LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2022
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 CLEVELAND AVE S STE B5
SAINT PAUL MN
55105-1255
US

IV. Provider business mailing address

909 EDGEWATER AVE
SHOREVIEW MN
55126-3807
US

V. Phone/Fax

Practice location:
  • Phone: 651-269-0485
  • Fax:
Mailing address:
  • Phone: 651-269-6920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4036
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: