Individual
MARISA IRENE GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Credential
LICSW
Contact information
Practice address
2525 CHICAGO AVE, MINNEAPOLIS, MN 55404-4518
(612) 813-6000
Mailing address
3124 COLUMBUS AVE, MINNEAPOLIS, MN 55407-1535
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
26510
MN
Other
Enumeration date
11/18/2025
Last updated
11/18/2025
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