MEDICARE: DANIEL GIGSTAD

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1699076620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL GIGSTAD

Provider Business Mailing Address
First Line	:	3013 ZENITH AVE UNIT B
Second Line	:
City	:	SPIRIT LAKE
State	:	IA
Zip	:	51360-2134
Country	:	US
Telephone Number	:	952-715-0480
Fax Number	:

Provider Business Practice Location Address
First Line	:	3717 KEOKUK AVE
Second Line	:
City	:	SPIRIT LAKE
State	:	IA
Zip	:	51360
Country	:	US
Telephone Number	:	952-715-0480
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2010
Last Update Date	:	05/21/2018

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Directions to “ DANIEL GIGSTAD ” Practice Location

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