Individual
MAIDA G GUNTHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
3601 MINNESOTA DR STE 200, BLOOMINGTON, MN 55435-5202
(612) 879-1000
(612) 879-9116
Mailing address
3601 MINNESOTA DR STE 200, BLOOMINGTON, MN 55435-5202
(612) 879-1000
(612) 879-9116
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
LP3565
MN
103T00000X
Psychologist
LP3565
MN
103TC0700X
Clinical Psychologist
LP3565
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
392G5GU
BLUE CROSS BLUE SHIELD
MN
05
—
482415600
—
MN
01
—
61-78167
UNITED BEHAVIORAL HEALTH
MN
Enumeration date
12/20/2005
Last updated
08/26/2024
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