Healthcare Provider Details

I. General information

NPI: 1750368353
Provider Name (Legal Business Name): ABIGAIL HADASSAH GEWIRTZ PHD, LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 08/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 UNIVERSITY AVE WEST STE 229N
ST PAUL MN
55114
US

IV. Provider business mailing address

1088 OVERLOOK RD
MENDOTA HEIGHTS MN
55118
US

V. Phone/Fax

Practice location:
  • Phone: 651-645-3115
  • Fax: 651-645-2752
Mailing address:
  • Phone: 651-365-1249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP4278
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: