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Individual

DR. JEFFREY GOTTLIEB

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PH.D.

Contact information

Practice address
2545 CHICAGO AVENUE SOUTH, MOB BUILDING, 7TH FLOOR, MINNEAPOLIS, MN 55404
(612) 863-4471
Mailing address
80 ARTHUR AVENUE SOUTHEAST, MINNEAPOLIS, MN 55414-3410
(651) 647-0442

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP1651
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
111748300
MN
Enumeration date
06/27/2005
Last updated
03/20/2015
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