Individual
GWEN BRUTLAG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., L.P.
Contact information
Practice address
220 W WASHINGTON AVE, WELLS FARGO BANK BUILDING, SUITE 204, FERGUS FALLS, MN 56537-2569
(218) 739-8761
(218) 739-8581
Mailing address
220 W WASHINGTON AVE, WELLS FARGO BANK BUILDING, SUITE 204, FERGUS FALLS, MN 56537-2569
(218) 739-8761
(218) 739-8581
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP 1204
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1991028
FED ID NUMBER
—
01
—
LP 1204
LISENCE NUMBER
MN
Enumeration date
04/10/2007
Last updated
07/08/2007
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