Organization
MICHAEL GORMLEY LP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAN WIRTZ (BILLING OFFICE MGR)
(952) 442-7015
Entity
Organization
Contact information
Practice address
610 CHESTNUT ST, GLENCOE, MN 55336-1028
(320) 864-4725
Mailing address
610 CHESTNUT ST, GLENCOE, MN 55336-1028
(320) 864-4725
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP0509
MN
Other
Enumeration date
07/26/2007
Last updated
07/26/2007
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