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NPI Code Detail

MEDICARE: THERESA L GUNDERSON PHD

MEDICARE: THERESA L GUNDERSON PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistLP4545MN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4680016226OTHERRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1938S8GUOTHERMNBCBS
2HP49455OTHERMNHEALTH PARTNERS
32316538OTHERMNAMERICAS PPO
5104336OTHERMNUCARE
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7410849339560015008OTHERCHAMPUS
8NA2951042871OTHERMNPREFFERED ONE

General Provider Information

NPI Number : 1043298060
Entity Type Code : Individual
Provider Name (Legal Business Name) : THERESA L GUNDERSON PHD
Provider Business Mailing Address
First Line : 9400 ZANE AVE N
Second Line :
City : BROOKLYN PARK
State : MN
Zip : 55443-1814
Country : US
Telephone Number : 763-762-8800
Fax Number :
Provider Business Practice Location Address
First Line : 111 HUNDERTMARK RD STE 205N
Second Line :
City : CHASKA
State : MN
Zip : 55318-1586
Country : US
Telephone Number : 952-903-1370
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2006
Last Update Date : 05/20/2021

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Directions to “ THERESA L GUNDERSON PHD” Practice Location

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