Individual
DAVID GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
821 RAYMOND AVE STE 200, SAINT PAUL, MN 55114-1509
(651) 216-8899
Mailing address
1945 STANFORD AVE, SAINT PAUL, MN 55105-1655
(651) 216-8899
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
11191
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1025840
P1
MN
01
—
123775
UC
MN
01
—
12D53GI
BCBS
MN
01
—
46411
HP
MN
05
—
475526000
—
MN
01
—
62-51344
UBH
MN
Enumeration date
07/27/2006
Last updated
01/27/2009
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