Individual
THERESA L GUNDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
111 HUNDERTMARK RD STE 205N, CHASKA, MN 55318-1586
(952) 903-1370
Mailing address
9400 ZANE AVE N, BROOKLYN PARK, MN 55443-1814
(763) 762-8800
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP4545
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
104336
UCARE
MN
01
—
2316538
AMERICAS PPO
MN
05
—
332159200
—
MN
01
—
410849339560015008
CHAMPUS
—
01
—
680016226
RR MEDICARE
—
01
—
938S8GU
BCBS
MN
01
—
HP49455
HEALTH PARTNERS
MN
01
—
NA2951042871
PREFFERED ONE
MN
Enumeration date
01/09/2006
Last updated
05/20/2021
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