Healthcare Provider Details

I. General information

NPI: 1255462321
Provider Name (Legal Business Name): JEREMY J. GATTO LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 WEIR DRIVE SUITE 355
WOODBURY MN
55125-2273
US

IV. Provider business mailing address

8170 33RD AVE MS: 21110A
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 651-254-8580
  • Fax: 651-730-1700
Mailing address:
  • Phone: 952-883-5129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC11157
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number25289
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: