MEDICARE: GAIL UELLENDAHL 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
1	103T00000X	Psychologist	PSY12802	CA

General Provider Information

NPI Number	:	1710039805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAIL UELLENDAHL PHD

Provider Business Mailing Address
First Line	:	3324 BUTLER AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-1306
Country	:	US
Telephone Number	:	310-621-2530
Fax Number	:

Provider Business Practice Location Address
First Line	:	3324 BUTLER AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-1306
Country	:	US
Telephone Number	:	310-621-2530
Fax Number	:

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

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	06/01/2023

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Directions to “ GAIL UELLENDAHL PHD” Practice Location

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