Individual
DR. GARY EDWIN GUNDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ED. D, MS LP
Contact information
Practice address
702 SW 5TH ST, BRAINERD, MN 56401-3997
(218) 454-6369
Mailing address
28022 COUNTY ROAD 107, PEQUOT LAKES, MN 56472-3312
(218) 838-2448
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
LP2801
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1012381
PR ONE
MN
01
—
150743
BHP
MN
01
—
25543
HP
MN
01
—
4K588GU
BCBS
MN
01
—
62-47591
UBH
MN
Enumeration date
03/30/2007
Last updated
07/08/2007
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