Individual
JOHN L GUSTAVSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
2530 N 8TH ST, SUITE 204, GRAND JUNCTION, CO 81501-8857
(970) 245-3505
Mailing address
2530 N 8TH ST, SUITE 204, GRAND JUNCTION, CO 81501-8857
(970) 245-3505
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PSY.0000987
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07987001
—
CO
Enumeration date
01/20/2006
Last updated
10/30/2019
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