Individual
MRS. DENISE ROSE GUDVANGEN
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
LP
Contact information
Practice address
603 BRUCE ST, CROOKSTON, MN 56716
(218) 281-3940
(218) 281-6261
Mailing address
603 BRUCE ST, PO BOX 603, CROOKSTON, MN 56716-0603
(218) 281-3940
(218) 281-6261
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
3957
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
123671
UCARE MINNESOTA
MN
01
—
41B43JA
BCBS OF MN
MN
01
—
HP28754
HEALTH PARTNERS
—
Enumeration date
03/16/2006
Last updated
07/08/2007
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