Individual
GAIL L RISSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
2720 FAIRVIEW AVE N STE 100, ROSEVILLE, MN 55113-1306
(651) 241-5290
(651) 241-5140
Mailing address
2720 FAIRVIEW AVE N STE 100, ROSEVILLE, MN 55113-1306
(651) 241-5290
(651) 377-8474
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
LP1122
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
703752000
—
MN
Enumeration date
07/16/2006
Last updated
02/10/2022
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