Individual
GWEN MARIE MILLAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
11812 WAYZATA BLVD, SUITE 212, MINNETONKA, MN 55305-2012
(612) 251-5795
Mailing address
3940 DREW AVE S, MINNEAPOLIS, MN 55410-1048
(612) 251-5795
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
16697
MN
Other
Enumeration date
06/20/2007
Last updated
07/08/2007
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