Individual
LORI GILDERSLEEVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LP
Contact information
Practice address
102 MARTY DR, BUFFALO, MN 55313-9305
(763) 682-5420
(763) 682-5803
Mailing address
102 MARTY DR, BUFFALO, MN 55313-9305
(763) 682-5420
(763) 682-5803
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP3779
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1022556
PREFERRED ONE
MN
01
—
149M6GI
BLUE CROSS BLUE SHEILD
MN
01
—
6243251
MEDICA
MN
01
—
HP28740
HEALTHPARTNERS
MN
Enumeration date
09/04/2006
Last updated
07/08/2007
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