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General NPI Number Information
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NPI Number | 1073506846
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Entity Type | Individual
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Provider Name | GARY D VIKESLAND PHD
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Gender | Male
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Dates
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Enumeration Date | 08/26/2005
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Last Update Date | 01/17/2024
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Provider Practice Location Address
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Address Line | 10700 OLD COUNTY ROAD 15 STE 170
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City | PLYMOUTH
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State | MN
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Zip | 55441-8709
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Country | US
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Telephone | 763-525-8590
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Fax | 763-525-8592
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Provider Business Mailing Address
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Address Line | 10700 OLD COUNTY RD 15 SUITE 170
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City | PLYMOUTH
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State | MN
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Zip | 55441
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Country | US
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Telephone | 763-525-8590
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Fax | 763-525-8592
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | LP3160
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License Number State | MN
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