Individual
JANET M GAGNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA LP
Contact information
Practice address
4301 W 62ND ST, EDINA, MN 55424-1954
(952) 920-2772
Mailing address
4301 W 62ND ST, EDINA, MN 55424-1954
(952) 920-2772
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP 3951
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1575334
MINNESOTA TAX ID
MN
01
—
LP3951
STATEPSYCHOLOGY LICENSE
MN
Enumeration date
02/06/2007
Last updated
07/08/2007
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