Individual
DR. DONAE VERBENA GUSTAFSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY. D.
Contact information
Practice address
6120 OREN AVE N, STILLWATER, MN 55082-6155
(651) 430-0888
(651) 430-0889
Mailing address
6120 OREN AVE N, STILLWATER, MN 55082-6155
(651) 430-0888
(651) 430-0889
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP 3566
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000-562-8542
AETNA
MN
01
—
11-5651
U CARE
MN
01
—
58G12GU
BCBS OF MN
MN
01
—
61-62456
MEDICA
MN
01
—
76-83570-00
MN MA
MN
05
—
76-83570-00
—
MN
01
—
HP16320
HEALTHPARTNERS
MN
Enumeration date
12/22/2006
Last updated
05/12/2010
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