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General NPI Number Information
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NPI Number | 1730130758
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Entity Type | Individual
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Provider Name | GAIL ANN NOLLER PSYD, LP
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Gender | Female
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 02/28/2019
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Provider Practice Location Address
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Address Line | 199 COON RAPIDS BLVD NW SUITE 310
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City | COON RAPIDS
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State | MN
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Zip | 55433-5831
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Country | US
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Telephone | 763-785-8111
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Fax | 763-785-8111
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Provider Business Mailing Address
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Address Line | 1416 OAKWOOD DR
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City | ANOKA
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State | MN
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Zip | 55303-2747
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Country | US
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Telephone | 763-427-6897
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Fax |
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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 | LP3194
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | LP3194
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License Number State | MN
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